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Chia JS, Chang C, Yang CH, Yang CH, Chiang YT, Wu CE. An operational maintenance approach for improving physiological monitor by HFMEA process: an empirical case study. Ann Med Surg (Lond) 2023; 85:3916-3924. [PMID: 37554888 PMCID: PMC10405987 DOI: 10.1097/ms9.0000000000001064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/02/2023] [Indexed: 08/10/2023] Open
Abstract
UNLABELLED This study explored the application of healthcare failure mode and effect analysis (HFMEA) to identify and evaluate risk-associated factors in the intensive care unit (ICU) through a clinical-based expert knowledge (decision) for the physiological monitor operational maintenance process. METHODS AND INTERVENTION A mixed qualitative and quantitative proactive approach to explore the HFMEA process by analyzing 20 units of physiological monitors in the ICU. An HFMEA expert team of six people was formed to perform a risk-based analysis and evaluate the potential hazard index, mitigating the hazard scores and risks. RESULTS From the main processes and possible failure reasons, one high-risk hazard index greater than or equal to 8 of the standard score was found. This standard score indicates the signed manufacturer's contract for maintenance was the hazard index failure mode on the parts not regularly replaced according to the contract. This systematic hazard index failure mode shows the highest hazard scores in the possible failure reason category, established as a standard maintenance procedure. In addition, the HFMEA expert analysis of the 20 units of physiological monitors within 6 months of the original and remanufactured part maintenance results in operational availability from 90.9% for self-repair to 99.2% for contract manufacturer repair. CONCLUSIONS This study concludes a systematic reference in malpractices caused by maintenance negligence. The HFMEA expert team agrees that hazard failure scores greater than or equal to 8 are vital assessments and evaluations for decision-making, especially in maintaining healthcare intensive unit care physiological monitors.
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Affiliation(s)
| | - Ching Chang
- Department of Business Administration, College of Management
| | - Chen-Hsuan Yang
- Industry-University Education Center, Chung Hua University, Hsinchu
| | - Ching-Hui Yang
- General Education Center, Hungkuang University, Taichung
| | - Yung-Tai Chiang
- Kinesiology, Health and Leisure, Chienkuo Technology University, Changhua, Taiwan, ROC
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Hirner S, Dhakal J, Broccoli MC, Ross M, Calvello Hynes EJ, Bills CB. Defining measures of emergency care access in low-income and middle-income countries: a scoping review. BMJ Open 2023; 13:e067884. [PMID: 37068910 PMCID: PMC10111883 DOI: 10.1136/bmjopen-2022-067884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Over 50% of annual deaths in low-income and middle-income countries (LMICs) could be averted through access to high-quality emergency care. OBJECTIVES We performed a scoping review of the literature that described at least one measure of emergency care access in LMICs in order to understand relevant barriers to emergency care systems. ELIGIBILITY CRITERIA English language studies published between 1 January 1990 and 30 December 2020, with one or more discrete measure(s) of access to emergency health services in LMICs described. SOURCE OF EVIDENCE PubMed, Embase, Web of Science, CINAHL and the grey literature. CHARTING METHODS A structured data extraction tool was used to identify and classify the number of 'unique' measures, and the number of times each unique measure was studied in the literature ('total' measures). Measures of access were categorised by access type, defined by Thomas and Penchansky, with further categorisation according to the 'Three Delay' model of seeking, reaching and receiving care, and the WHO's Emergency Care Systems Framework (ECSF). RESULTS A total of 3103 articles were screened. 75 met full study inclusion. Articles were uniformly descriptive (n=75, 100%). 137 discrete measures of access were reported. Unique measures of accommodation (n=42, 30.7%) and availability (n=40, 29.2%) were most common. Measures of seeking, reaching and receiving care were 22 (16.0%), 46 (33.6%) and 69 (50.4%), respectively. According to the ECSF slightly more measures focused on prehospital care-inclusive of care at the scene and through transport to a facility (n=76, 55.4%) as compared with facility-based care (n=57, 41.6%). CONCLUSIONS Numerous measures of emergency care access are described in the literature, but many measures are overaddressed. Development of a core set of access measures with associated minimum standards are necessary to aid in ensuring universal access to high-quality emergency care in all settings.
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Affiliation(s)
- Sarah Hirner
- School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Jyotshila Dhakal
- College Undergraduate Degree Programs & Studies, University of Colorado Denver, Denver, Colorado, USA
| | | | - Madeline Ross
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Emilie J Calvello Hynes
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Corey B Bills
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
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Lario R, Kawamoto K, Sottara D, Eilbeck K, Huff S, Del Fiol G, Soley R, Middleton B. A method for structuring complex clinical knowledge and its representational formalisms to support composite knowledge interoperability in healthcare. J Biomed Inform 2023; 137:104251. [PMID: 36400330 DOI: 10.1016/j.jbi.2022.104251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/08/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The use and interoperability of clinical knowledge starts with the quality of the formalism utilized to express medical expertise. However, a crucial challenge is that existing formalisms are often suboptimal, lacking the fidelity to represent complex knowledge thoroughly and concisely. Often this leads to difficulties when seeking to unambiguously capture, share, and implement the knowledge for care improvement in clinical information systems used by providers and patients. OBJECTIVES To provide a systematic method to address some of the complexities of knowledge composition and interoperability related to standards-based representational formalisms of medical knowledge. METHODS Several cross-industry (Healthcare, Linguistics, System Engineering, Standards Development, and Knowledge Engineering) frameworks were synthesized into a proposed reference knowledge framework. The framework utilizes IEEE 42010, the MetaObject Facility, the Semantic Triangle, an Ontology Framework, and the Domain and Comprehensibility Appropriateness criteria. The steps taken were: 1) identify foundational cross-industry frameworks, 2) select architecture description method, 3) define life cycle viewpoints, 4) define representation and knowledge viewpoints, 5) define relationships between neighboring viewpoints, and 6) establish characteristic definitions of the relationships between components. System engineering principles applied included separation of concerns, cohesion, and loose coupling. RESULTS A "Multilayer Metamodel for Representation and Knowledge" (M*R/K) reference framework was defined. It provides a standard vocabulary for organizing and articulating medical knowledge curation perspectives, concepts, and relationships across the artifacts created during the life cycle of language creation, authoring medical knowledge, and knowledge implementation in clinical information systems such as electronic health records (EHR). CONCLUSION M*R/K provides a systematic means to address some of the complexities of knowledge composition and interoperability related to medical knowledge representations used in diverse standards. The framework may be used to guide the development, assessment, and coordinated use of knowledge representation formalisms. M*R/K could promote the alignment and aggregated use of distinct domain-specific languages in composite knowledge artifacts such as clinical practice guidelines (CPGs).
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Affiliation(s)
- Robert Lario
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | | | - Karen Eilbeck
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Stanley Huff
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States; Graphite Health, Salt Lake City, UT, United States
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
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Ahmadpour P, Moosavi S, Mohammad-Alizadeh-Charandabi S, Jahanfar S, Mirghafourvand M. Effect of implementing a birth plan on maternal and neonatal outcomes: a randomized controlled trial. BMC Pregnancy Childbirth 2022; 22:862. [PMID: 36419027 PMCID: PMC9682672 DOI: 10.1186/s12884-022-05199-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The birth plan is an approach for pregnant women to offering their expectations of labor and birth. The purpose of this study was to investigate the effect of birth plan on maternal and neonatal outcomes. METHODS This study was a randomized controlled clinical trial performed on 106 pregnant women, 32-36 weeks of pregnancy, referring to Taleghani educational hospital in Tabriz city-Iran. Participants were randomly assigned to the two groups of birth plan and control using a randomized block method. Participants in the birth plan group received the interventions based on the mother's requested birth plan. The birth plan included items of the mother's preferences in labor, mobility, eating and drinking, monitoring, pain relief, drug options, labor augmentation, pushing, amniotomy, episiotomy, infant care, and caesarean section. The control group received routine hospital care. The primary outcomes were childbirth experience and duration of the active phase of labor and the secondary outcomes were support and control in labor, fear of labor, post-traumatic stress disorder (PTSD), postpartum depression, duration of the second and third phases of labor, frequency of vaginal delivery, frequency of admission of newborn in NICU (Neonatal Intensive Care Unit), the mean first and fifth minute Apgar scores. The socio-demographic and obstetrics characteristics questionnaire, Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ-versions A), and Edinburgh Postnatal Depression Scale (EPDS) were completed at the beginning of the study (at the gestational age of 32-36 weeks). The questionnaire of delivery information, neonatal information, and Delivery Fear Scale (DFS) was completed during and after the delivery. Also, a partogram was completed for all participants by the researcher. The participants in both groups followed up until 4-6 weeks post-delivery, whereby the instruments of Childbirth Experience Questionnaire 2.0 (CEQ2.0), Support and Control In Birth (SCIB) scale, EPDS, and PTSD Symptom Scale 1 (PSS-I) were completed by the researcher through an interview. The independent t-test, the chi-square test, and ANCOVA was used to analyze. RESULTS The mean (SD) of CEQ score was singificnalty higher in in the birth plan group (3.2 ± 0.2) compared to the control (2.1 ± 0.2) (MD = 1.0; 95% CI: 1.1 to 0.9; P˂0.001). Also, the mean (SD) SCIB score in the birth plan group was significantly higher than that of those in the control group (P˂0.001). The mean scores of DFS (P = 0.015), EPDS (P˂0.001), and PTSD (P˂0.001) as well as the frequency of emergency caesarean section (P = 0.007) in the birth plan group were significantly lower than those in the control group. CONCLUSION This was the first study to assess the implementation of a birth plan in Iran. Based on the findings, a birth plan improves childbirth experiences; increases perceived support and control in labor; reduces fear of delivery; suppresses psychological symptoms of depression and PTSD, and increases the frequency of vaginal delivery. TRIAL REGISTRATION Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N58. Date of registration: 07/07/2020; URL: https://en.irct.ir/trial/47007 ; Date of first registration: 19/07/2020.
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Affiliation(s)
- Parivash Ahmadpour
- grid.412888.f0000 0001 2174 8913Students’ Research Committee, Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sanaz Moosavi
- grid.412888.f0000 0001 2174 8913Women Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz , Iran
| | | | - Shayesteh Jahanfar
- grid.253856.f0000 0001 2113 4110Public Health Department, Central Michigan University, Michigan, USA
| | - Mojgan Mirghafourvand
- grid.412888.f0000 0001 2174 8913Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz , Iran
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Seufert S, de Cruppé W, Assheuer M, Leinert J, Geraedts M. How do patients respond to safety problems in ambulatory care? Results of a retrospective cross-sectional telephone survey. BMJ Open 2021; 11:e052973. [PMID: 34753764 PMCID: PMC8578976 DOI: 10.1136/bmjopen-2021-052973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 10/18/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Patients in German ambulatory care frequently report patient safety problems (PSP). It is unclear whether patients report PSP back to their general practitioner (GP) or specialist in charge. This study reports on how patients respond to experienced PSP. DESIGN Retrospective cross-sectional study. SETTING Computer-assisted telephone interviews (CATI) with randomly recruited citizens aged ≥40 years in Germany. PARTICIPANTS 10 037 citizens ≥40 years. About 52% of the interviewees were female, 38% were between 60 and 79 years old and about 47% reported that they were chronically ill. A total of 2589 PSPs was reported. PRIMARY AND SECONDARY MEASURES/RESULTS According to the respondents (n=1422, 77%, 95% CI: 74.7 to 79.1), 72% (95% CI: 70.2 to 73.7) of PSP were reported back to the GP in charge or to another GP/specialist. Further reactions were taken by 65% (95% CI: 62.5 to 67.5) of the interviewees: around 63% (95% CI: 62.5 to 66.2) of the reported PSP led to a loss of faith in the physician or to complaints. χ2 and binary logistic regression analyses show significant associations between the (a) reporting and (b) reaction behaviour and determinants like 'medical treatment area' ((a) χ2=17.13, p=0.009/(b) χ2=97.58, p=0.000), 'PSP with/without harm' ((a) χ2=111.84, p=0.000/(b) χ2=265.39, p=0.000) and sociodemographic characteristics when respondents are aged between 40 and 59 years ((a) OR 2.57/(b) OR 2.60) or have chronic illnesses ((a) OR 2.16/(b) OR 2.14). CONCLUSION The data suggest that PSPs are frequently reported back to the GP or specialist in charge and have a significant serious impact on the physician-patient relationship. Much could be learnt from the patient reporting and reacting behaviour to prevent PSPs in ambulatory care.
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Affiliation(s)
- Svenja Seufert
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Germany
| | - Werner de Cruppé
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Germany
| | - Michaela Assheuer
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Germany
| | - Johannes Leinert
- infas Institut fur angewandte Sozialwissenschaft GmbH, Bonn, Germany
| | - Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Germany
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Neilson M, Leatherman S, Syed S. The quality-of-care agenda in fragile, conflict-affected and vulnerable settings. Bull World Health Organ 2021; 99:170-170A. [PMID: 33716335 PMCID: PMC7941104 DOI: 10.2471/blt.21.285627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Matthew Neilson
- Department of Integrated Health Services, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Sheila Leatherman
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, United States of America
| | - Shamsuzzoha Syed
- Department of Integrated Health Services, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
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Affiliation(s)
| | - Kenneth I Shine
- Department of Internal Medicine, Dell Medical School, University of Texas, Austin
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