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Adverse drug events in the elderly population admitted to a tertiary care hospital.

https://arctichealth.org/en/permalink/ahliterature188411
Source
J Healthc Manag. 2002 Sep-Oct;47(5):295-305; discussion 305-6
Publication Type
Article
Author
Nahid Azad
Michael Tierney
Gary Victor
Parul Kumar
Author Affiliation
Faculty of Medicine, Geriatric Assessment Unit, Ottawa Hospital Civic Campus, Canada. nazad@ottawahospital.on.ca
Source
J Healthc Manag. 2002 Sep-Oct;47(5):295-305; discussion 305-6
Language
English
Publication Type
Article
Keywords
Adverse Drug Reaction Reporting Systems
Aged
Aged, 80 and over
Cohort Studies
Drug Prescriptions
Drug Therapy - utilization
Drug Utilization Review
Drug-Related Side Effects and Adverse Reactions
Female
Health Services Research
Hospital Bed Capacity, 500 and over
Hospitals, Teaching - standards - utilization
Humans
Incidence
Inpatients - statistics & numerical data
Length of Stay - statistics & numerical data
Male
Ontario - epidemiology
Polypharmacy
Prospective Studies
Abstract
Older adults take almost one-third of the drugs prescribed today yet represent only about 12 percent of the population. Adverse drug events are common in this population, but often these events appear to be preventable. Interest in adverse events related to the use of prescription drugs has rarely been higher or broader. The research community continues to develop new tools to study adverse effects of drugs in individuals and populations. However, the published literature on drug-related adverse events is fraught with problems, starting with the original reports and extending to systematic reviews. Prospective data are missing, adverse drug events are poorly described, and analytical methods are questionable. This leads to problems with imprecise estimates and generalizability of results.
PubMed ID
12325252 View in PubMed
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Adverse events among medical patients after discharge from hospital.

https://arctichealth.org/en/permalink/ahliterature181686
Source
CMAJ. 2004 Feb 3;170(3):345-9
Publication Type
Article
Date
Feb-3-2004
Author
Alan J Forster
Heather D Clark
Alex Menard
Natalie Dupuis
Robert Chernish
Natasha Chandok
Asmat Khan
Carl van Walraven
Author Affiliation
Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada. aforster@ohri.ca
Source
CMAJ. 2004 Feb 3;170(3):345-9
Date
Feb-3-2004
Language
English
Publication Type
Article
Keywords
Adverse Drug Reaction Reporting Systems
Aged
Aged, 80 and over
Canada
Cross Infection - complications
Female
Hospitals, Teaching - standards
Humans
Male
Medical Errors - adverse effects - statistics & numerical data
Middle Aged
Outcome Assessment (Health Care)
Patient Discharge
Prospective Studies
Quality Assurance, Health Care
Abstract
Adverse events (AEs) are adverse outcomes caused by medical care. Several studies have indicated that a substantial number of patients experience AEs before or during hospitalization. However, few data describe AEs after hospital discharge. We determined the incidence, severity, preventability and ameliorability of AEs in patients discharged from the general internal medicine service of a Canadian hospital.
At a multisite Canadian teaching hospital, we prospectively studied patients who were consecutively discharged home or to a seniors' residence from the general internal medicine service during a 14-week interval in 2002. We used telephone interview and chart review to identify outcomes after discharge. Two physicians independently reviewed each outcome to determine if the patient experienced an AE. The severity, preventability and ameliorability of all AEs were classified.
During the study period, outcomes were determined for 328 of the 361 eligible patients, who averaged 71 years of age (interquartile range 54-81 years). After discharge, 76 of the 328 patients experienced at least 1 AE (overall incidence 23%, 95% confidence interval [CI] 19%-28%). The AE severity ranged from symptoms only (68% of the AEs) or symptoms associated with a nonpermanent disability (25%) to permanent disability (3%) or death (3%). The most common AEs were adverse drug events (72%), therapeutic errors (16%) and nosocomial infections (11%). Of the 76 patients, 38 had an AE that was either preventable or ameliorable (overall incidence 12%, 95% CI 9%-16%).
Approximately one-quarter of patients in our study had an AE after hospital discharge, and half of the AEs were preventable or ameliorable.
Notes
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Comment In: CMAJ. 2004 May 25;170(11):1647, 1650; author reply 165015159350
Comment In: CMAJ. 2004 Feb 3;170(3):353-414757671
Erratum In: CMAJ. 2004 Mar 2;170(5):771
PubMed ID
14757670 View in PubMed
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["And so we'll equally evaluate..." When the education was evaluated].

https://arctichealth.org/en/permalink/ahliterature194097
Source
Ugeskr Laeger. 2001 Jun 25;163(26):3633-5
Publication Type
Article
Date
Jun-25-2001
Author
B. Eika
B. Wallstedt
C V Ringsted
Author Affiliation
Aarhus Universitet, Enhed for Medicinsk Uddannelse. be@medu.au.dk
Source
Ugeskr Laeger. 2001 Jun 25;163(26):3633-5
Date
Jun-25-2001
Language
Danish
Publication Type
Article
Keywords
Denmark
Education, Medical - standards
Evaluation Studies as Topic
Humans
Quality Assurance, Health Care
Questionnaires
Teaching - standards
PubMed ID
11445985 View in PubMed
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Antibiotic misuse in a pediatric teaching hospital.

https://arctichealth.org/en/permalink/ahliterature246176
Source
Can Med Assoc J. 1980 Jan 12;122(1):49-52
Publication Type
Article
Date
Jan-12-1980
Author
E. Schollenberg
W L Albritton
Source
Can Med Assoc J. 1980 Jan 12;122(1):49-52
Date
Jan-12-1980
Language
English
Publication Type
Article
Keywords
Anti-Bacterial Agents - therapeutic use
Child
Drug Utilization
Hospital Bed Capacity, 100 to 299
Hospitals, Pediatric - standards
Hospitals, Special - standards
Hospitals, Teaching - standards
Humans
Manitoba
Medical Audit
Substance-Related Disorders
Utilization Review
Abstract
Antibiotic use at a pediatric teaching hospital was reviewed for a month. A total of 188 courses of therapy were evaluated with respect to choice of antibiotic, dosage and necessity of treatment. Errors in therapy were noted in 30% of the medical orders and 63% of the surgical orders. The most frequent error, unnecessary therapy, was found in 13% and 45% of the medical and surgical orders respectively. Error rates were highest for the most frequently ordered antibiotics, notably the penicillins. The magnitude of the problem appeared to be similar to that previously reported from general ana adult hospitals. The difficulties with solutions such as educational programs and compulsory consultation are discussed.
Notes
Cites: J Infect Dis. 1969 Jun;119(6):662-55795107
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Cites: Lancet. 1977 Nov 26;2(8048):1118-2273021
Cites: Mt Sinai J Med. 1978 Jul-Aug;45(4):489-94309073
Cites: Surg Gynecol Obstet. 1965 Feb;120:243-5414257927
Cites: Surgery. 1961 Jul;50:161-816722001
PubMed ID
7363195 View in PubMed
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The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada.

https://arctichealth.org/en/permalink/ahliterature179979
Source
CMAJ. 2004 May 25;170(11):1678-86
Publication Type
Article
Date
May-25-2004
Author
G Ross Baker
Peter G Norton
Virginia Flintoft
Régis Blais
Adalsteinn Brown
Jafna Cox
Ed Etchells
William A Ghali
Philip Hébert
Sumit R Majumdar
Maeve O'Beirne
Luz Palacios-Derflingher
Robert J Reid
Sam Sheps
Robyn Tamblyn
Author Affiliation
Department of Health Policy, Management and Evaluation, University of Toronto, McMurrich Building Room 2031, 12 Queen's Park Crescent West, Toronto, Ontario M5S 1A8, Canada. ross.baker@utoronto.ca
Source
CMAJ. 2004 May 25;170(11):1678-86
Date
May-25-2004
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Health Facility Size
Hospital Mortality
Hospitals, Community - standards - statistics & numerical data - utilization
Hospitals, Teaching - standards - statistics & numerical data - utilization
Humans
Iatrogenic Disease - epidemiology - prevention & control
Incidence
Length of Stay - statistics & numerical data
Medical Audit - methods
Medical Errors - prevention & control - statistics & numerical data
Patient Admission - statistics & numerical data
Patient Advocacy
Safety Management - standards
Abstract
Research into adverse events (AEs) has highlighted the need to improve patient safety. AEs are unintended injuries or complications resulting in death, disability or prolonged hospital stay that arise from health care management. We estimated the incidence of AEs among patients in Canadian acute care hospitals.
We randomly selected 1 teaching, 1 large community and 2 small community hospitals in each of 5 provinces (British Columbia, Alberta, Ontario, Quebec and Nova Scotia) and reviewed a random sample of charts for nonpsychiatric, nonobstetric adult patients in each hospital for the fiscal year 2000. Trained reviewers screened all eligible charts, and physicians reviewed the positively screened charts to identify AEs and determine their preventability.
At least 1 screening criterion was identified in 1527 (40.8%) of 3745 charts. The physician reviewers identified AEs in 255 of the charts. After adjustment for the sampling strategy, the AE rate was 7.5 per 100 hospital admissions (95% confidence interval [CI] 5.7- 9.3). Among the patients with AEs, events judged to be preventable occurred in 36.9% (95% CI 32.0%-41.8%) and death in 20.8% (95% CI 7.8%-33.8%). Physician reviewers estimated that 1521 additional hospital days were associated with AEs. Although men and women experienced equal rates of AEs, patients who had AEs were significantly older than those who did not (mean age [and standard deviation] 64.9 [16.7] v. 62.0 [18.4] years; p = 0.016).
The overall incidence rate of AEs of 7.5% in our study suggests that, of the almost 2.5 million annual hospital admissions in Canada similar to the type studied, about 185 000 are associated with an AE and close to 70 000 of these are potentially preventable.
Notes
Cites: Med Care. 2000 Mar;38(3):261-7110718351
Cites: CMAJ. 1999 Jun 1;160(11):1585-610374000
Cites: J Eval Clin Pract. 1997 Aug;3(3):213-229406109
Cites: Ann Intern Med. 1996 Sep 15;125(6):457-648779457
Cites: Med J Aust. 1995 Nov 6;163(9):458-717476634
Cites: N Engl J Med. 1991 Feb 7;324(6):377-841824793
Cites: N Engl J Med. 1991 Feb 7;324(6):370-61987460
Cites: BMJ. 2000 Mar 18;320(7237):768-7010720363
Cites: Can J Surg. 2000 Apr;43(2):113-710812345
Cites: Int J Qual Health Care. 2000 Oct;12(5):371-811079216
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Cites: CMAJ. 2004 Feb 3;170(3):345-914757670
Cites: Biometrics. 1977 Mar;33(1):159-74843571
Comment In: CMAJ. 2004 Oct 12;171(8):833; author reply 83415477611
Comment In: CMAJ. 2004 Oct 12;171(8):833-4; author reply 83415477610
Comment In: CMAJ. 2004 Oct 12;171(8):832; author reply 83415477609
Comment In: CMAJ. 2004 Oct 12;171(8):829, 832; author reply 83415477606
Comment In: CMAJ. 2004 May 25;170(11):1688-915159368
Comment In: CMAJ. 2004 Oct 12;171(8):834; author reply 83415477613
Comment In: CMAJ. 2010 Aug 10;182(11):121420696812
PubMed ID
15159366 View in PubMed
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Canadian nurses' perceptions of patient safety in hospitals.

https://arctichealth.org/en/permalink/ahliterature188031
Source
Can J Nurs Leadersh. 2002 Sep-Oct;15(3):11-21
Publication Type
Article
Author
Wendy Nicklin
Janice E McVeety
Author Affiliation
Allied Health and Clinical Programs, The Ottawa Hospital, ON. wnicklin@ottawahospital.on.ca
Source
Can J Nurs Leadersh. 2002 Sep-Oct;15(3):11-21
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Focus Groups
Health Care Surveys
Hospitals, Teaching - standards
Humans
Nurses - psychology
Quality of Health Care
Risk
Safety Management - methods
Social Perception
Abstract
The topic of patient safety within the health care system is receiving increasing attention. The Academy of Canadian Executive Nurses conducted a national survey on nurses' perceptions of patient safety, using focus groups from Academic Health Science Centres. Over a three month time frame, 22 organizations, and 33 focus groups comprised of 503 nurses provided responses to six questions regarding patient safety in hospitals. The study was designed as a preliminary fact finding initiative resulting in this descriptive report of the concerns as identified within the focus groups. With each issue identification, they were coded and grouped into 23 themes. Nurses overwhelmingly responded that the health care environment, in which they provide care, presents escalating risk to their patients. In particular, Workload/Pace of Work, Human Resources, Nursing Shortage/Staffing, Restructuring/Bed Closures, Patients/Clients, Systems Issues, Physical Environment and Technology/Specialization were themes emphasized as contributing to increased risk in patient care. Health care leaders must play a key role in developing strategies to address the issues nurses have identified and demonstrate a commitment to controlling the situation. This study encourages research into a more explicit understanding of the issues and identification of strategies to address patient safety in health care.
Notes
Erratum In: Can J Nurs Leadersh. 2002 Nov-Dec;15(4):5.
PubMed ID
12395972 View in PubMed
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Canadian ophthalmology residency training: an evaluation of resident satisfaction and comparison with international standards.

https://arctichealth.org/en/permalink/ahliterature148285
Source
Can J Ophthalmol. 2009 Oct;44(5):540-7
Publication Type
Article
Date
Oct-2009
Author
Alysia W Zhou
Jason Noble
Wai-Ching Lam
Author Affiliation
Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont.
Source
Can J Ophthalmol. 2009 Oct;44(5):540-7
Date
Oct-2009
Language
English
Publication Type
Article
Keywords
Adult
Canada
Clinical Competence - standards
Competency-Based Education
Curriculum - standards
Education, Medical, Graduate - standards
Educational Status
Female
Health Knowledge, Attitudes, Practice
Humans
Internationality
Internship and Residency - standards
Male
Ophthalmology - education
Professional Practice
Questionnaires
Teaching - standards
Abstract
To evaluate the adequacy of Canadian ophthalmology residency programs in achieving the competencies outlined by the International Council of Ophthalmology (ICO) and to assess residents' satisfaction with their training programs.
Canadian residents enrolled in the final 2 years of English and French ophthalmology programs, as well as recent graduates from 2005 to 2008.
Graduates and eligible residents were invited to participate in the 43-item survey during the autumn of 2008. Data were categorized by demographic variables, and basic statistics were done.
Of the 99 individuals surveyed, 40 (40%) responded, representing 26 current residents and 14 graduates. The vast majority (85%) of respondents were satisfied with their residency program. Clinic-based training was generally rated satisfactorily; however, respondents reported insufficient exposure to low-vision rehabilitation (77.5%), refraction and glasses prescription (65%), and neuro-ophthalmology (45%). Respondents were similarly satisfied with their surgical experiences, most of them (>60%) rating case volume, complexity, and variety as satisfactory or better. However, many stated that they had insufficient exposure to extracapsular cataract extraction (72.5%), refractive surgery (72.5%), and orbital surgery (57.5%). Of the graduates surveyed, all passed their Royal College licensing examinations on the first attempt and felt that residency adequately prepared them for the examinations. They reported insufficient training in certain nonclinical areas, such as practice management, and staffing and administration skills.
Canadian ophthalmology residents express high levels of satisfaction with their residency training programs. Although most programs appear to adequately address most ICO core objectives, certain curriculum modifications are required.
PubMed ID
19789589 View in PubMed
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Changes in Physical Performance During 21 d of Military Field Training in Warfighters.

https://arctichealth.org/en/permalink/ahliterature299652
Source
Mil Med. 2018 05 01; 183(5-6):e174-e181
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
05-01-2018
Author
Tommi Ojanen
Keijo Häkkinen
Tommi Vasankari
Heikki Kyröläinen
Author Affiliation
Finnish Defence Research Agency, Finnish Defence Forces, P.O. Box 5, 04401 Järvenpää, Finland.
Source
Mil Med. 2018 05 01; 183(5-6):e174-e181
Date
05-01-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Body Composition - physiology
Body mass index
Finland
Humans
Male
Military Personnel - statistics & numerical data
Muscle Strength - physiology
Physical Endurance - physiology
Physical Functional Performance
Surveys and Questionnaires
Teaching - standards - statistics & numerical data
Young Adult
Abstract
Few studies have reported the amount of physical activity (PA) and its associations to physical performance of warfighters during military field training (MFT). The purpose of this study was to investigate changes in neuromuscular performance and PA among male Finnish Army conscripts during a 21-d MFT and to evaluate their recovery during 4 d after MFT.
Body composition and physical performance were measured four times during the study (before MFT (PRE), after 12 d (MID), post training (POST) and after 4 d of recovery (RECO)). PA was measured throughout MFT in a group of healthy young male conscripts (n=49) by using a tri-axial accelerometer. The study was approved by the Finnish Defence Forces and was granted ethics approval by the Ethics Committee of the University of Jyväskylä.
Body mass declined significantly from 73.5 ± 8.7 to 71.6 ± 8.2 kg, but it recovered close to the PRE values (73.0 ± 8.3 kg). The same trend was also found in skeletal muscle mass and fat mass. The change in body mass and in skeletal muscle mass correlated negatively with the change in vigorous physical activity (r = -0.374, p = 0.016, and r = -0.337, p = 0.031, respectively). Muscular endurance decreased significantly (p
PubMed ID
29420780 View in PubMed
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Characteristics of 'best' and 'worst' clinical teachers as perceived by university nursing faculty and students.

https://arctichealth.org/en/permalink/ahliterature235212
Source
J Adv Nurs. 1987 May;12(3):331-7
Publication Type
Article
Date
May-1987
Author
J. Morgan
J E Knox
Source
J Adv Nurs. 1987 May;12(3):331-7
Date
May-1987
Language
English
Publication Type
Article
Keywords
Adult
Canada
Education, Nursing, Baccalaureate
Faculty, Nursing - standards
Humans
Middle Aged
Nursing Care
Social Perception
Students, Nursing - psychology
Teaching - standards
United States
Abstract
This study identified and compared characteristics of 'best' and 'worst' clinical teachers as perceived by university nursing faculty and students. The Nursing Clinical Teacher Effectiveness Inventory (NCTEI) was distributed to 201 volunteer subjects. This survey instrument, developed by the authors, contains 48 clinical teacher characteristics grouped into five categories. Each participant was asked to rate, using the NCTEI, the 'best' and them the 'worst' clinical teacher from past observations. Results showed both groups perceived that being a good role model was the highest rated characteristic for 'best' teachers and the 'lowest' rated characteristic for 'worst' teachers. Faculty and students' perceptions were fairly similar as to highest rated characteristics of 'best' clinical teachers. Less agreement was noted about the characteristics of 'worst' clinical teachers. When categories of clinical teacher characteristics were compared, there were significant differences between the ratings of faculty and students for 'best' clinical teachers, but none for 'worst' clinical teachers.
PubMed ID
3648076 View in PubMed
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Checklists in the operating room: Help or hurdle? A qualitative study on health workers' experiences.

https://arctichealth.org/en/permalink/ahliterature138498
Source
BMC Health Serv Res. 2010;10:342
Publication Type
Article
Date
2010
Author
Oyvind Thomassen
Guttorm Brattebø
Jon-Kenneth Heltne
Eirik Søfteland
Ansgar Espeland
Author Affiliation
Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. oyvt@helse-bergen.no
Source
BMC Health Serv Res. 2010;10:342
Date
2010
Language
English
Publication Type
Article
Keywords
Anesthesiology - manpower - standards
Attitude of Health Personnel
Checklist
Focus Groups
Hospitals, Teaching - standards
Humans
Intensive Care Units
Medical Staff, Hospital - psychology
Norway
Nursing Staff, Hospital
Operating Rooms
Physicians
Qualitative Research
Surgery Department, Hospital - manpower - standards
Abstract
Checklists have been used extensively as a cognitive aid in aviation; now, they are being introduced in many areas of medicine. Although few would dispute the positive effects of checklists, little is known about the process of introducing this tool into the health care environment. In 2008, a pre-induction checklist was implemented in our anaesthetic department; in this study, we explored the nurses' and physicians' acceptance and experiences with this checklist.
Focus group interviews were conducted with a purposeful sample of checklist users (nurses and physicians) from the Department of Anaesthesia and Intensive Care in a tertiary teaching hospital. The interviews were analysed qualitatively using systematic text condensation.
Users reported that checklist use could divert attention away from the patient and that it influenced workflow and doctor-nurse cooperation. They described senior consultants as both sceptical and supportive; a head physician with a positive attitude was considered crucial for successful implementation. The checklist improved confidence in unfamiliar contexts and was used in some situations for which it was not intended. It also revealed insufficient equipment standardisation.
Our findings suggest several issues and actions that may be important to consider during checklist use and implementation.
Notes
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PubMed ID
21171967 View in PubMed
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71 records – page 1 of 8.