Journal Of Patient safety and quality improvement
Volume:7 Issue: 2, Spring 2019

Diagnostic reasoning is a key skill practised by clinicians. It is a process by which correct clinical diagnosis is reached. Learning theories offer some guidance on how this cognitive skill is best taught; what curriculum best supports it and how it is learned and used by expert and novice learners. Novice and expert learners have different needs when it comes to developing this skill. This paper aims to explore the unique role of the medical educator; exploring how they facilitate diagnostic reasoning amongst learners with an emphasis on improving patient safety. The bibliography assembled for this literature review includes original articles, quantitative and qualitative papers, narrative review articles, editorials and other documents identified through PubMed, Scopus, ERIC, Australian Education Index, British Education Index and Google Scholar Database searches. Results – Medical educators employ a variety of teaching strategies including ‘thinking aloud’ techniques and hypothesis generation. There is some dispute in the literature as to which teaching strategies and which curricula best support the learning of diagnostic reasoning. The contribution of good diagnostic reasoning skills in reducing clinical error and maintaining patient safety is clear.Conclusions – It is important to continue to encourage the teaching of diagnostic reasoning with an emphasis on patient safety and its role in reducing clinical error and adverse events for patients.

This article discusses how Brazilian physicians think about medical errors and the consequences on their professional careers. A retrospective study with a qualitative approach based on the professional experience of Brazilian physicians who work in a private hospital in Sao Paulo, Brazil. The participants were twenty Brazilian physicians, including ten without medical errors and ten with medical errors. In-depth interviews were conducted with the physicians, and content analysis was conducted based on the phenomenological method.  No significant difference between the two groups was found. Both groups indicated that there is no error-free practice and that educational and health institutions offer no specific training for what to do when an error occurs. Physicians believe that they should not let themselves be influenced by society’s judgment of a physician who commits an error or by the medical error concept. The Brazilian media and society tend to blame physicians for their errors. The availability of a service or an institution that supports physicians who have committed a medical error is important because these professionals do not feel supported when an error occurs and feel that they require mental health support to face the ethical and civil proceedings. Well-established doctor-patient relationships can promote the well-being of medical practitioners. It is necessary to implement training and institutional practices that specify conduct conducive to improving Brazilian medical practice.

The goal of ergonomics science is to achieve an effective adaptation between the user and the workstation to improve productivity, increase the safety and reduce occupational injuries. Therefore, this study was conducted with the aim of studying knowledge about ergonomics, determining working conditions and occupational injuries of nurses in selected hospitals of Shahid Beheshti University of Medical Sciences. This cross-sectional study was done on nurses working in hospitals affiliated to Shahid Beheshti University of Medical Sciences by one standard questionnaire. Using descriptive statistics, Kolmogorov-Smirnov, chi-square, independent t-test and one-way ANOVA, data were analyzed. The mean and standard deviation of age and work experience were about 32.67 ± 8.63 and 8.84 ± 7.46 years, respectively. Results showed the level of nurses 'knowledge about ergonomics with an average of 0.72 ± 3.14 was good. Also, the extent of occupational problems and injuries, such as musculoskeletal disorders (MSDs), with a mean of 0.95 ± 2.10 was also weak. The results showed that there was a significant reverse relationship between the level of knowledge of ergonomic science and the level of occupational injury (P-value = 0.00, R = -0.299) and between working conditions and occupational injuries (P-value = 0.000, R = -0.357). There was a reverse relationship between the level of knowledge of ergonomic and occupational injuries. Also, there was a significant reverse relationship between working conditions and occupational injuries. Therefore, use of training and ergonomic interventions can be useful.

Finding optimum time of post ablation whole body iodine scan in patients with differentiated thyroid cancer(DTC) treated with I-131. 20 patients with DTC, who were treated with I131 underwent post ablation whole body iodine scan (WBIS) in days 4, 7 and 9 after treatment. A dual head gamma camera (e-cam, Siemens) equipped with high energy parallel hole collimator was used for imaging. The images were acquired with 7cm/min and stored in a 1024 ×256 matrix. 3 Patients had negative WBIS in all three sets of imaging and 17 patients had postsurgical thyroid remnants on all 3 scans. On days 4 and 7 we detected 11 patients with cervical lymph node metastases while on day 9 only 9 patients showed cervical lymph node metastases.(P=0.135)On all 3 sets of images, we encountered 4 patients with mediastinal lymph node metastases and 1 patient with bone metastasis. In addition, all 3 sets of images detected lung metastases in three patients. The total number of affected foci did not have any statistical differences in whole body scan of day 4, 7 and 9. (P = 0.083) According to the radiation safety hazards for staff and technicians of nuclear medicine department and lack of difference in scan findings between 4 and 7 days after RAI, scanning the DTC patients in the day 7 after RAI administration , is more practicable, with less probability of missing the sites of involvement. Performing whole body iodine scans after 1 week is not recommended.

Medical incidents occur frequently, necessitating a more effective prevention policy. Nurses have the highest employment rates in the healthcare occupations; therefore, they are a key to improving patient safety. Most reports of errors have focused on medicine errors by nurses or patient falls; however, the effects of different types of error and nurses’ experience have not been examined. The present study aimed to elucidate the factors that influence differences in reported near-miss incidents across clinical experience levels and department assignments. A quantitative study was conducted using published data from the Japan Council for Quality Health Care. We analysed clinical experience level by near miss types. A total of 17,105 cases were analysed (14,896 drug near misses, 1,857 medical device near misses, and 162 nursing near misses). Participants had a mean of 7.4 years of experience and a mean of 2.3 years within the department. Statistically significant differences between clinical experience level, events, drug administration, and medical devices used were observed. However, no differences were found in terms of nursing care near misses. Length of department assignment was related to the “human factors” in participants at Novice/Advanced beginner levels, as well as “environment/facilities and devices” in those at Competent and Proficient/Expert levels. The percentage of “environment/facilities and devices” that caused near misses with drugs and medical devices increased as clinical experience increased. The present study described the characteristics of clinical experience levels, providing meaningful information useful for developing new educational paradigms for effective training.

Bleeps represent an important element of the on-call neurosurgical registrar’s workday. They provide instant contact between healthcare staff, while allowing doctors to perform tasks across the hospital. However the paging system causes interruptions and can interfere with patient care. We aim to develop and implement strategies to improve paging patterns and ultimately reduce unnecessary calls. we conducted a retrospective analysis of electronic hospital bleep records over a 7-months period (March-September-2015) in which bleep logs were retrieved from the hospital paging system at University Hospital of Wales. The first cycle was followed by a set of interventions followed by a second data-collection cycle 12 months later. The first cycle showed that on average the neurosurgical registrar received 57 bleeps per 24hrs. Almost a third of on-call bleeps were new referrals received from the local accident & emergency department or from other district hospitals. Other calls were received from our own hospital’s wards and Intensive Therapeutic Unit (10%), the paediatric ward (5%), neurosurgical theatres (5%) and emergency theatre (5%). The second cycle showed a 23% drop in the total number of bleeps compared to first cycle. The difference in bleep numbers was evident during the day shift, and no difference was noted during the night shift. No difference in the number of new referrals was noted. This project has shown that a simple change can result in a significant improvement. It also confirmed the value of team work and communication in improving quality of care.

Prostate carcinoma is the most common type of cancer and the second lethal cancer in men. Overexpression of Her2-neu gene affects the growth and prognosis of some tumors. HER2 gene amplification is seen in about one-third of prostatic adenocarcinoma cases.it also seems to correlate with androgen independence of the prostate tumors. We evaluated the HER2-neu expression in prostate cancer and its relation with known prognostic factors, in this study. Immunohistochemical staining was used to evaluate the expression of Her2-neu in 60 cases of prostate carcinoma. The relation between HER2-neu expression and prognostic factors of prostatic carcinoma was evaluated,which included serum PSA values , number of core involvement, high percentage of core involvement,Gleason score,Gleason grade,extra prostatic extension of the tumoral cells and tumor volume. Among 60 patients included in our study ,Her2-neu was negative in 49 (81.7%) cases (zero score in 35 cases and score 1+ in 14 cases) , and a weakly positive expression (score 2+) was seen in 11 (%18/3) cases.Among evaluated factors, tumor volume was the only factor which significantly correlated with Her2-neu expression. The rate of Her2-neu expression was not high in our patients. Among various variables evaluated in our study,only tumor volume had significant statistical correlation with the expression of Her2-neu. According to low expression of Her2-neu in evaluated specimens in this study, it is necessary to conduct more studies to confirm the relationship of her2-neu and the known prognostic factors of prostate carcinoma.

Burns have impacts including medical, psychological, economic and social that involve patients and health care system. Epidemiologic factors of burns vary in different societies. While the effects of some burn variables on mortality rate, in similar circumstances, are expected to be universal. The present study was carried out to analyze the epidemiology, mortality, and current etiological factors of burn injuries. This cross-sectional study was conducted during a period of 6 years (from 2010 to 2015). Data were obtained by the analysis of medical records of patients hospitalized in the Imam Reza Burn Center in Mashhad, Iran. The data were recorded by the nurses and staffs in the burn ward. In our study, 1334 in-hospital burn patients were recorded. The mean age was 27 ± 5.67 years. The most common mechanism of burn was flame. The multivariable logistic regression modeling revealed, that the most important risk factors of patient mortality were length of stay (LOS) (OR=2.53(95% CI: 1.75-3.66), percentage of burn regarding body surface (BBS) OR=10.64(95% CI: 7.58-14.43), degree of burns OR=6.39(95% CI: 1.46-27.99).  The results of our study revealed a high incidence of burns. Prevention plans should be made in this regard