Patient safety in outpatient surgery: the viewpoint of the healthcare providers

The objective of this study is to understand the viewpoint of healthcare providers with regard to patient safety in outpatient surgery settings. Two methods were used to gather data from the healthcare providers: (1) questionnaire with open-ended questions about six predefined stages of the patient care process; (2) survey with closed questions. With the first method, the main quality and safety of care issues concerned communication to patients, coordination of reports and forms, patient and staff time pressures and standards of care. The first two stages of the outpatient surgery process, i.e. patient work-up prior to day of surgery and patient admission and preparation on the day of surgery, yielded many more comments than the other four stages. The results of the structured questionnaire show that, overall, the healthcare providers report high quality of care provided by themselves (98%) and their surgery centre (96%). With regard to patient safety (i.e. cancellations of surgeries, patient safety problems and serious mistakes), there was a clear difference in perceptions reported by the physicians vs. the nurses and other staff. Nurses and other staff were more likely to report patient safety problems than physicians. The combination of qualitative data from the initial questionnaire and the quantitative data from the structured questionnaire provides a rather complete view of the outpatient surgery staff perceptions of quality and safety of care. This research highlights the importance of getting input from the healthcare providers regarding the quality and safety of care rather than relying only on traditional measures about patient outcomes.     

SOAT1: A Suitable Target for Therapy in High-Grade Astrocytic Glioma?

Targeting molecular alterations as an effective treatment for isocitrate dehydrogenase-wildtype glioblastoma (GBM) patients has not yet been established. Sterol-O-Acyl Transferase 1 (SOAT1), a key enzyme in the conversion of endoplasmic reticulum cholesterol to esters for storage in lipid droplets (LD), serves as a target for the orphan drug mitotane to treat adrenocortical carcinoma. Inhibition of SOAT1 also suppresses GBM growth. Here, we refined SOAT1-expression in GBM and IDH-mutant astrocytoma, CNS WHO grade 4 (HGA), and assessed the distribution of LD in these tumors. Twenty-seven GBM and three HGA specimens were evaluated by multiple GFAP, Iba1, IDH1 R132H, and SOAT1 immunofluorescence labeling as well as Oil Red O staining. To a small extent SOAT1 was expressed by tumor cells in both tumor entities. In contrast, strong expression was observed in glioma-associated macrophages. Triple immunofluorescence labeling revealed, for the first time, evidence for SOAT1 colocalization with Iba1 and IDH1 R132H, respectively. Furthermore, a notable difference in the amount of LD between GBM and HGA was observed. Therefore, SOAT1 suppression might be a therapeutic option to target GBM and HGA growth and invasiveness. In addition, the high expression in cells related to neuroinflammation could be beneficial for a concomitant suppression of protumoral microglia/macrophages.     

Measurement of CH4-concentration in HMDSO-containing process plasmas by quantum cascade laser absorption spectroscopy

For thin film deposition or plasma etching often organic precursors are used in the process plasma and related transient species are formed. In general it is not possible to measure the converted quantity of these precursors directly. In the present work we have used a special laser absorption spectroscopy to investigate characteristic molecular lines in the plasma to determine the concentration of stable organic molecules. Quantum cascade laser absorption spectroscopy (QCLAS) is a rather new technique for the precise measurement of absolute molecule concentrations. QCL’s can be operated at room temperature. They emit light within the mid infrared and have similar spectroscopic characteristics to Tunable Diode Lasers (TDL). The commercially available system Q-MACS (Quantum Cascade Laser Measurement and Control System) offers a solid platform for the measurement of absolute molecule concentrations in plasmas and gas mixtures. The used Q-MACS is due to its laser characteristics particularly well suitable for determination of the concentrations of acetylene and methane. Molecular concentrations of methane were measured in hexamethyldisiloxane (HMDSO) containing plasmas, too. The methane concentration was found to depend on rf power and HMDSO flow.     

Immunization of Aotus monkeys with recombinant Plasmodium falciparum hybrid proteins does not reproducibly result in protection from malaria infection

Plasmodium falciparum antigens SERP, HRPII, MSAI, and 41-3 have shown promise as vaccine components. This study aimed at reproducing and extending previous results using three hybrid molecules. Antibody responses were reproduced in Aotus monkeys, but solid protection from a P. falciparum blood-stage challenge that showed an unintendedly enhanced pathogenicity was not observed.     

Role network measures to assess healthcare team adaptation to complex situations: the case of venous thromboembolism prophylaxis

Hospitals are complex environments that rely on clinicians working together to provide appropriate care to patients. These clinical teams adapt their interactions to meet changing situational needs. Venous thromboembolism (VTE) prophylaxis is a complex process that occurs throughout a patient’s hospitalisation, presenting five stages with different levels of complexity: admission, interruption, re-initiation, initiation, and transfer. The objective of our study is to understand how the VTE prophylaxis team adapts as the complexity in the process changes; we do this by using social network analysis (SNA) measures. We interviewed 45 clinicians representing 9 different cases, creating 43 role networks. The role networks were analysed using SNA measures to understand team changes between low and high complexity stages. When comparing low and high complexity stages, we found two team adaptation mechanisms: (1) relative increase in the number of people, team activities, and interactions within the team, or (2) relative increase in discussion among the team, reflected by an increase in reciprocity.

 

Practitioner Summary: The reason for this study was to quantify team adaptation to complexity in a process using social network analysis (SNA). The VTE prophylaxis team adapted to complexity by two different mechanisms, by increasing the roles, activities, and interactions among the team or by increasing the two-way communication and discussion throughout the team. We demonstrated the ability for SNA to identify adaptation within a team.     

A computer-based reporting system in radiology of the chest

The aim of this study was to compare our computer-aided report writing system to standard techniques. A computer-aided reporting system for reporting on chest X-rays was developed and linked with a UNIX-based radiology information system. The reporting system consists of different text modules which can be composed to a complete radiological report. The quality of the report, the system's efficiency, flexibility and availability at the radiology information system (RIS), as well as its acceptance by the users, were criteria we took as a basis of evaluation. Acceptance and flexibility of the system were tested by assessing necessary changes and additions performed to text modules and by subjective evaluation. The time spent on working with the reporting system was evaluated by performing a time-analysis study comparing the new system to the two conventional methods, the tape system and handwriting. On average, the readers needed 22.6 text modules for each report. For the users the most important advantages of the new system are that primarily fewer changes to or additions to the text are necessary, and when they cannot be avoided they can be performed more easily. In comparison with the tape system and handwritten reports, it took on average two and a half to three times longer to report on a chest X-ray. The printed report had left the department within 6.4 h using the tape system within 0.4 h when handwritten and within 1.4 h when recorded by the reporting system. The completeness of the set of modules and the logical order were positively assessed by the users. The demand of time for reporting increases, but the final report is available sooner.     

Serine-stretch protein (SERP) of Plasmodium falciparum corresponds to the exoantigen Ag2, a target of antibodies associated with protection against malaria

The frequency of peripheral blood cells expressing the perforin gene or the granzyme B gene was evaluated by in situ hybridization in nine patients suffering from metastatic melanoma and treated with recombinant interleukin-2 (rIL-2). A spontaneous expression of both genes was detected in five to seven patients. rIL-2 administration increased the frequency of positive cells in all patients (P < 0.03 for each gene), the highest frequency being reached in the patients who already expressed these genes prior to rIL-2 treatment (P < 0.02). Expressions of the granzyme B gene and of the perforin gene were strongly correlated before IL-2 treatment and they were similarly affected by rIL-2 administration. In contrast, their modification under treatment did not correlate with that of CD56+ cell counts, of natural killer activity and of sCD8 release. This indicates that perforin and granzyme B gene expressions are markers of cytotoxic cell activation independent of those previously described, and that they should be further evaluated in patients with malignancies to delineate their potential value in predicting clinical outcome.     

Alkalischer Polyolaufschluss als Basis für eine Lignocellulose‐Bioraffinerie

The utilization of lignocellulose as renewable feedstock for the chemical industry necessitates the development of sustainable pulping processes. A new process is introduced enabling the effective fractionation not only of annual fiber plants or hardwood but also of more resistant softwoods. The resulting ultrapure pulp is free of inhibiting degradation products and can be almost completely enzymatically hydrolyzed.     

Care transitions in the outpatient surgery preoperative process: facilitators and obstacles to information flow and their consequences

Patient care transitions have been shown to be critical points at which failure as well as recovery from potential failure may occur. The purpose of this research was to identify transitions in patient care and the flow of associated information at different steps in the outpatient surgery preoperative care process and, in turn, attempt to identify breakdowns in the information flow process and their ramifications. A study of one organization’s preoperative process for outpatient surgery was conducted, employing four means of data collection to gather information on preoperative work processes: employee shadowing, patient shadowing, clinic observation, and dictated feedback. Various facilitators and obstacles in information flow were found to be present in the preoperative care process. Obstacles often resulted in negative consequences for healthcare providers and patients. Helping care providers understand how their actions affect the various elements of the preoperative process, through improved awareness, may be one way to improve information flow problems within the outpatient surgery process.