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Koker A, Tekerek NÜ, Nalbant GŞE, Çebişli E, Dursun O. Factors Affecting the Quality of Life of Parents Caring for Pediatric Patients with a Tracheostomy. J Pediatr Intensive Care 2023; 12:330-336. [PMID: 37974559 PMCID: PMC10631839 DOI: 10.1055/s-0043-1771345] [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: 05/25/2023] [Accepted: 06/11/2023] [Indexed: 11/19/2023] Open
Abstract
Objectives This study aimed to evaluate factors affecting the quality of life (QOL) of parents of children who underwent placement of a tracheostomy while in the pediatric intensive care unit (PICU) through postdischarge use of a standardized questionnaire, Functional Status Scale (FSS) for patients, and WHOQoL-BREF (a QOL scale) for parents. Methods The parents were initially contacted by telephone, postdischarge, during which the standardized questionnaire was completed. The functional status of the patients was evaluated using the FSS, and the QOL of parents was determined through use of the WHOQoL-BREF scale. Results From 2011 to 2021, tracheostomy was performed in 119 PICU patients. Overall, 93 patients were excluded due to death in 66 (56%), decannulation in 24 (20%) and, 3 (2%) were not available for follow-up. The parents of 26 (22%) patients were available for follow-up and for which the standardized questionnaire FSS and WHOQoL-BREF QOL scales were completed. The mean FSS score of the patients was elevated at 17.84. In comparison, reduced mean scores were observed for parental physical health of 20.61, psychological health of 20.57, social health of 11.15, and environmental health of 29.00. As a result, a moderate ( r < 0.80), yet significant ( p ≤ 0.004) negative correlation was found between the FSS scores of patients and the physical, social relationships, environmental, and psychological health QOL scores of parents. Conclusion This study is unique in that, to our knowledge, it is the first to compare parental QOL with the FSS of pediatric patients who have undergone a tracheostomy while hospitalized in the PICU. Our findings indicate that the parental QOL was reduced in four areas and correlates with an elevation in FSS score (indicating a greater functional disorder) of pediatric patients who had previously undergone a tracheostomy while hospitalized in the PICU.
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Affiliation(s)
- Alper Koker
- Division of Pediatric Critical Care, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkiye
| | - Nazan Ülgen Tekerek
- Division of Pediatric Critical Care, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkiye
| | | | - Erdem Çebişli
- Division of Pediatric Critical Care, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkiye
| | - Oguz Dursun
- Division of Pediatric Critical Care, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkiye
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2
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Alotaibi FZ, Alkhatabi R, Allowaihiq L, Alhazzani H, Alshehri G, Hajr EA, Alkholaiwi F. Assessment of the ability, perception, and readiness of nurses to manage tracheostomy-related complications in Riyadh City: a cross-sectional study. BMC Nurs 2022; 21:320. [PMID: 36419082 PMCID: PMC9682812 DOI: 10.1186/s12912-022-01101-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/10/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Nursing staff play a key role in the bedside management of tracheostomized patients in both intensive care units and general floors. Effective provision of postoperative care to these patients by nurses is critical. This study aimed to assess the readiness of nursing staff to manage tracheostomy-related complications in Riyadh, Saudi Arabia. METHODS This cross-sectional study enrolled 395 nurses in Riyadh, Saudi Arabia. A self-administered questionnaire developed by the authors was distributed to nurses via an online survey. The questionnaire assessed nurses' socio-demographic characteristics and their knowledge and practices regarding tracheostomy indications, postoperative care, and management of its complications. RESULTS Of respondents, approximately 59% (232/395) had poor knowledge regarding tracheostomy-related complications and indications, 39% (154/395) had moderate knowledge, and only 2%(9/395) had good knowledge. Several factors were associated with increased knowledge, including having a higher education degree, working in a tertiary/quaternary hospital, being a government employee, caring for tracheostomized patients, and attending courses or lectures on managing tracheostomized patients. CONCLUSIONS Knowledge level and practices regarding tracheostomy-related complications and indications among nurses remain limited. In-service continuous professional development programs for nurses working in all hospital settings are strongly recommended. Further research is warranted to elicit the major factors contributing to inadequate knowledge and practices among nurses in Riyadh.
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Affiliation(s)
- Fahad Zarraq Alotaibi
- College of Medicine, Imam Mohammed Ibn Saud Islamic University, Othman Bin Affan Road Alnada-7544, 13317-4233 Riyadh, Kingdom of Saudi Arabia ,grid.440750.20000 0001 2243 1790Department of Otorhinolaryngology-Head and Neck Surgery, Imam Mohammad Ibn Saud Islamic University, Othman Bin Affan Road Alnada-7544, 13317-4233 Riyadh, Kingdom of Saudi Arabia
| | - Reema Alkhatabi
- College of Medicine, Imam Mohammed Ibn Saud Islamic University, Othman Bin Affan Road Alnada-7544, 13317-4233 Riyadh, Kingdom of Saudi Arabia
| | - Lujain Allowaihiq
- College of Medicine, Imam Mohammed Ibn Saud Islamic University, Othman Bin Affan Road Alnada-7544, 13317-4233 Riyadh, Kingdom of Saudi Arabia
| | - Hassan Alhazzani
- grid.56302.320000 0004 1773 5396College of Medicine, King Saud University, King Khalid Road 11451, Riyadh, 2454-1145 Saudi Arabia
| | - Ghada Alshehri
- College of Medicine, Imam Mohammed Ibn Saud Islamic University, Othman Bin Affan Road Alnada-7544, 13317-4233 Riyadh, Kingdom of Saudi Arabia
| | - Eman A. Hajr
- College of Medicine, Imam Mohammed Ibn Saud Islamic University, Othman Bin Affan Road Alnada-7544, 13317-4233 Riyadh, Kingdom of Saudi Arabia ,grid.440750.20000 0001 2243 1790Department of Otorhinolaryngology-Head and Neck Surgery, Imam Mohammad Ibn Saud Islamic University, Othman Bin Affan Road Alnada-7544, 13317-4233 Riyadh, Kingdom of Saudi Arabia
| | - Feras Alkholaiwi
- College of Medicine, Imam Mohammed Ibn Saud Islamic University, Othman Bin Affan Road Alnada-7544, 13317-4233 Riyadh, Kingdom of Saudi Arabia ,grid.440750.20000 0001 2243 1790Department of Otorhinolaryngology-Head and Neck Surgery, Imam Mohammad Ibn Saud Islamic University, Othman Bin Affan Road Alnada-7544, 13317-4233 Riyadh, Kingdom of Saudi Arabia
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Mosalli R, Aboumoustafa GA, Khayyat W, Bokhari AN, Almatrafi MA, Ghazi M, Paes B. Assessment of Nurses' Knowledge and Confidence Regarding Tracheostomy Care in a Pediatric Long Term Care Hospital in Saudi Arabia. Risk Manag Healthc Policy 2022; 15:1809-1821. [PMID: 36171869 PMCID: PMC9512020 DOI: 10.2147/rmhp.s374730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 09/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background The incidence of tracheostomy insertion in pediatric patients has increased over the last few decades. Tracheostomized pediatric patients need daily, meticulous care by qualified nurses to minimize severe, avoidable complications. Adequately trained nurses facilitate patients’ stability, accelerate weaning from the ventilator, and reduce potential tracheostomy dislodgement. Methods A cross-sectional, retrospective cohort survey was conducted in September 2021, using an electronic version of a self-questionnaire, to assess nurses’ knowledge and comfort level regarding tracheostomy care of pediatric patients at the International Extended Care Center in Jeddah, Saudi Arabia. Statistical analysis of the accrued data was performed using the SPSS 21.0 software package and a P-value <0.05 calculated by t-Test, was considered significant. Results Among 43 nurses included in the study, 14 (32.6%) were very comfortable taking care of tracheostomized patients, 13 (30.2%) were comfortable, and 16 (37.2%) were uncomfortable. Regarding knowledge, three main aspects of tracheostomy care were correctly answered (%) by all the nurses: knowledge of routine tracheal care (55%), tracheal care skills (11.6%), and tracheal emergency care (2.3%). The study showed a significant positive correlation between nurses’ comfort level with tracheal care and academic degree, duration of pediatric experience, completion of more than one life support course, and attendance at the annual local tracheostomy care competency learning program (TCCLP; all P <0.05). Conclusion Deficits exist in nurses’ knowledge of tracheostomy care. Improved knowledge garnered through repetitive participation in tracheostomy competency programs and life support courses correlate with greater comfort and more than 5 years of pediatric experience. Nurses’ deficits in emergency care knowledge and skills should be addressed through a structured educational program and a simulation, hands-on based TCCLP course, irrespective of comfort level with tracheostomy care.
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Affiliation(s)
- Rafat Mosalli
- Department of Pediatrics, International Extended Care Center, Jeddah, Saudi Arabia.,Department of Pediatrics, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Gamal A Aboumoustafa
- Department of Pediatrics, International Extended Care Center, Jeddah, Saudi Arabia
| | - Wed Khayyat
- Medical College, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Aziza N Bokhari
- Medical College, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - Mohammed Ghazi
- Department of Pediatrics, International Extended Care Center, Jeddah, Saudi Arabia.,Department of Pediatrics, Division of Critical Care, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
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Zhang Q, Wan L, Chen Q, Li C, Wang N, Wang Y, Li Y, Huang J, Hu Q. Prevention of Severe Respiratory Tract Infection and Prognosis in Neurosurgical Patients with Severe Tracheotomy Based on 5E Rehabilitation Nursing Model. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2727679. [PMID: 35836924 PMCID: PMC9276491 DOI: 10.1155/2022/2727679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/21/2022]
Abstract
Background Continuous nursing based on 5E rehabilitation mode can improve the physiology and psychology of patients to some extent. The purpose of this study was to explore the effect of continuous nursing of 5E rehabilitation mode on the prevention and prognosis of severe respiratory tract infection in patients with severe tracheotomy in neurosurgery. Objective To explore the effect of 5E rehabilitation nursing model on the prevention of severe respiratory tract infection and prognosis in patients with severe tracheotomy in neurosurgery. Methods The starting and ending time of this study is from February 2019 to July 2021. In this paper, 60 patients with severe tracheotomy were divided into the control group and research group according to random number table method. The former group received routine nursing, and the latter group received rehabilitation nursing model based on 5E. The patients' satisfaction, oxygenation index, partial pressure of carbon dioxide, partial pressure of oxygen, SAS, SDS score, incidence of severe respiratory tract infection, and quality of life scores were compared. Results The nursing satisfaction of the research group was higher than that of the control group (P < 0.05). 24 hours after weaning, the oxygenation index and partial pressure of oxygen in the research group were higher than those in the control group, while the partial pressure of carbon dioxide in the research group was lower than that in the control group (P < 0.05). After nursing, the scores of self-rating anxiety scale and self-rating depression scale in the research group were lower than those in the control group, and the difference was statistically significant (P < 0.05). The incidence of severe respiratory tract infection in the research group was significantly lower than that in the control group (P < 0.05). After nursing, the scores of physiological function, psychological function, social function, and health self-cognition in the research group were lower than those in the control group (P < 0.05). Conclusion The nursing program of neurosurgical patients with severe tracheotomy based on 5E rehabilitation model can effectively enhance patients' nursing satisfaction, activities of daily living, anxiety, and depression and promote the prognosis.
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Affiliation(s)
- Qing Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Donghu Road-169, Wuhan, Hubei Province 430071, China
| | - Lei Wan
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Donghu Road-169, Wuhan, Hubei Province 430071, China
| | - Qin Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Donghu Road-169, Wuhan, Hubei Province 430071, China
| | - Chen Li
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Donghu Road-169, Wuhan, Hubei Province 430071, China
| | - Ningning Wang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Donghu Road-169, Wuhan, Hubei Province 430071, China
| | - Yang Wang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Donghu Road-169, Wuhan, Hubei Province 430071, China
| | - Yuanyuan Li
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Donghu Road-169, Wuhan, Hubei Province 430071, China
| | - Jingjing Huang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Donghu Road-169, Wuhan, Hubei Province 430071, China
| | - Qin Hu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Donghu Road-169, Wuhan, Hubei Province 430071, China
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Gaterega T, Mwiseneza MJ, Chironda G. Nurses knowledge and practices regarding tracheostomy care at a selected referral hospital in Rwanda – A descriptive cross-sectional study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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6
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Affiliation(s)
- Giuseppe A Marraro
- Healthcare Accountability Lab, University of Milan, Milan, Italy, and Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
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Rayess HM, Svider P, Hanba C, Patel VS, Carron M, Zuliani G. Adverse Events in Facial Implant Surgery and Associated Malpractice Litigation. JAMA FACIAL PLAST SU 2019; 20:244-248. [PMID: 29346485 DOI: 10.1001/jamafacial.2017.2242] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Facial implants represent an important strategy for providing instant and long-lasting volume enhancement to address both aging and posttraumatic defects. Objective To better understand risks of facial implants by examining national resources encompassing adverse events and considerations facilitating associated litigation. Design, Setting, and Participants A cross-sectional study reviewed complications following facial implants. The procedures reviewed were performed on patients at locations throughout the United States from January 2006 to December 2016. Data collection was completed in March 2017. The Manufacturer and User Facility Device Experience database, which contains medical device reports submitted to the US Food and Drug Administration (FDA), was searched for complications that occurred from January 2006 to December 2016 involving facial implants made by Implantech, MEDPOR, Stryker, KLS Martin, and Synthes. Furthermore, the Thomson Reuters Westlaw legal database was searched for relevant litigation. Main Outcomes and Measures The complications of facial implants were analyzed in relation to the location of implant and severity of complication. Litigation was analyzed to determine which factors determine outcome. Results Thirty-nine instances of adverse events reported to the FDA were identified. Sixteen (41%) involved malar implants, followed by 12 chin implants (31%). The most common complications included infection (18 [46%]), implant migration (9 [23%]), swelling (7 [18%]), and extrusion (4 [10%]). Thirty-two patients (83%) had to have their implants removed. Infection occurred at a mean (SD) of 83.3 (68.8) days following the surgery. One-third of complications involved either migration or extrusion. The mean (range) time to migration or extrusion was 381.1 (10-2400) days. In 12 malpractice cases identified in publicly available court proceedings, alleged inadequate informed consent and requiring additional surgical intervention (ie, removal) were the most commonly cited factors. Conclusions and Relevance Infection and implant migration or extrusion are the most common complications of facial implants. Most of these complications necessitate removal. These considerations need to be discussed with patients preoperatively as part of the informed consent process, as allegedly inadequate informed consent was cited in a significant proportion of resultant litigation, and there were overlapping considerations among adverse events reported to the FDA and factors brought up in relevant litigation. Cases resolved with settlements and jury-awarded damages encompassed considerable award totals. Level of Evidence NA.
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Affiliation(s)
- Hani M Rayess
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Peter Svider
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Curtis Hanba
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | | | - Michael Carron
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Giancarlo Zuliani
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
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8
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Ideker HC, Julakanti JS, Momin NA, Chaaban MR. Determination of legal responsibility in shared airway management between anesthesiology and otolaryngology. Head Neck 2019; 41:4181-4188. [PMID: 31502364 DOI: 10.1002/hed.25948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/13/2019] [Accepted: 08/21/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Malpractice litigation remains an important point of contention in the United States. Airway management often sees multidisciplinary teams of anesthesiologists and otolaryngologists. This report analyzes lawsuits affecting both teams in airway management. METHODS The Westlaw legal database (West Publishing Co., St. Paul, MN) was used to search for malpractice cases involving failed airway management, where both anesthesiology and otolaryngology were involved. RESULTS Among the 28 cases analyzed, otolaryngology and anesthesiology were most commonly sued together (46.4%). When sued together, defendants were less likely to win and average award amounts ($4, 558 716) were higher. These cases most commonly occurred in the operating room (78.6%), involved a difficult/improper intubation (39.3%), alleged a failure to follow standard of care (57%), and resulted in death (60.7%). CONCLUSION These cases primarily cited failure to follow standard of care and communication failures. Efforts should be directed toward multidisciplinary airway management protocols and effective communication.
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Affiliation(s)
- Henry C Ideker
- School of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Jatin S Julakanti
- School of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Nishat A Momin
- School of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Mohamad R Chaaban
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, Texas
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9
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Doherty C, Neal R, English C, Cooke J, Atkinson D, Bates L, Moore J, Monks S, Bowler M, Bruce IA, Bateman N, Wyatt M, Russell J, Perkins R, McGrath BA. Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies. Anaesthesia 2018; 73:1400-1417. [PMID: 30062783 DOI: 10.1111/anae.14307] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 01/09/2023]
Abstract
Temporary and permanent tracheostomies are required in children to manage actual or anticipated long-term ventilatory support, to aid secretion management or to manage fixed upper airway obstruction. Tracheostomies may be required from the first few moments of life, with the majority performed in children < 4 years of age. Although similarities with adult tracheostomies are apparent, there are key differences when managing the routine and emergency care of children with tracheostomies. The National Tracheostomy Safety Project identified the need for structured guidelines to aid multidisciplinary clinical decision making during paediatric tracheostomy emergencies. These guidelines describe the development of a bespoke emergency management algorithm and supporting resources. Our aim is to reduce the frequency, nature and severity of paediatric tracheostomy emergencies through preparation and education of staff, parents, carers and patients.
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Affiliation(s)
- C Doherty
- Department of Paediatric Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - R Neal
- Paediatric Intensive Care Medicine, Paediatrics, Birmingham Children's Hospital, Birmingham, UK
| | - C English
- Department of Paediatric ENT, Manchester University NHS Foundation Trust, Manchester, UK
| | - J Cooke
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital, London, UK
| | - D Atkinson
- Department of Anaesthesia and Intensive Care Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - L Bates
- Department of Anaesthesia and Intensive Care Medicine, Royal Bolton Hospital, Bolton, UK
| | - J Moore
- Department of Anaesthesia and Intensive Care Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - S Monks
- Department of Anaesthesia, East Lancashire Hospitals NHS Trust, Burnley, UK
| | - M Bowler
- Department of Paediatric Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - I A Bruce
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - N Bateman
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
| | - M Wyatt
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital, London, UK
| | - J Russell
- Department of Paediatric ENT, Our Lady's Children's Hospital, Dublin, Ireland
| | - R Perkins
- Department of Paediatric Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - B A McGrath
- Department of Anaesthesia and Intensive Care Medicine, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Clinical Indices Can Standardize and Monitor Pediatric Care: A Novel Mechanism to Improve Quality and Safety. J Pediatr 2018; 193:190-195.e1. [PMID: 29212624 DOI: 10.1016/j.jpeds.2017.09.073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 08/07/2017] [Accepted: 09/27/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The Cancer Care Index (CCI), a single metric that sums the number of undesirable patient events in a given time frame (either preventable harm events or missed opportunities to provide optimal care), resulted in a 42% improvement in performance. Our objective was to test the index concept in other service lines to determine whether similar performance improvement occurred. STUDY DESIGN Care indices were developed and introduced in 3 additional service lines: Nephrology (Chronic Kidney Disease Care Index; CKDCI), Pulmonology (Lung Transplantation Care Index; LTCI), and Otolaryngology (Tracheostomy Care Index; TCI). After reaching agreement on specific harms to be avoided and elements of optimal care that should be reliably delivered, these items were compiled into indices that were updated monthly. Reports included each element individually and the total for all elements. Baseline performance was calculated retrospectively for the previous year. RESULTS Significant improvement in performance occurred in each program following implementation of the clinical indices. The CKDCI was decreased by 63.2% (P < .001), the LTCI was decreased by 89.5% (P < .001), and the TCI was decreased by 53.0% (P < .001). Surveyed staff indicated satisfaction with use of the metric. CONCLUSIONS Clinical indices are useful for evaluating and managing the overall reliability of a program's ability to deliver optimal care, and are associated with improved clinical performance and satisfaction by service line staff when incorporated into a program's operation.
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CASASOLA-GIRÓN M, BENITO-OREJAS JI, BOBILLO-DE LAMO F, PARRA-MORAIS L, CICUÉNDEZ-ÁVILA R, MORAIS-PÉREZ D. Proyecto de seguridad del paciente traqueotomizado procedente de una unidad de cuidados críticos. REVISTA ORL 2017. [DOI: 10.14201/orl.16932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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12
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Gupta A, Svider PF, Rayess H, Sheyn A, Folbe AJ, Eloy JA, Zuliani G, Carron MA. Pediatric rhinoplasty: A discussion of perioperative considerations and systematic review. Int J Pediatr Otorhinolaryngol 2017; 92:11-16. [PMID: 28012510 DOI: 10.1016/j.ijporl.2016.10.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/24/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Pediatric rhinoplasty has traditionally raised numerous concerns, including its impact on growth as well as the psychological sequelae of undergoing a potentially appearance-altering procedure. Our objective was to critically evaluate available individual patient data relevant to pediatric rhinoplasty, and further discuss perioperative considerations. METHODS A systematic review was conducted using PubMed/MEDLINE databases. Data extracted and analyzed from included studies included patient demographics, surgical indications, operative approaches, outcomes, complications, revision rates, and other clinical considerations. RESULTS Seven studies encompassing 253 patients were included, with age ranging from 7 months to 19 years. Two-thirds of patients were male. 41.7% reported antecedent trauma, and common overall surgical indications included "functional aesthetic" (24.5%) followed by cleft lip nasal deformity (15.8%). The majority (79.1%) underwent open approaches, and 71.1% of patients underwent concomitant septal intervention. The most frequently used grafting materials were septal cartilage (52.8%) and conchal cartilage (16.5%). Surgical outcomes were heterogeneous among these studies. Complication rates were only specified in 5 of the 7 studies and totaled 57 patients (39.6%). Aesthetic dissatisfaction (11.8%) and postoperative nasal obstruction (5.6%) were the most commonly reported complications. Revisions were performed in 13.5%. CONCLUSION Rhinoplasty is safe in the pediatric population, although revisions rates appear greater than those reported in adults. This study of 253 represents the largest pooled sample size to date; nonetheless, non-standardized outcome measures, minimal long-term followup data, and lack of discussion regarding psychological sequelae all contribute to the need for further high-quality studies evaluating this topic.
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Affiliation(s)
- Amar Gupta
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
| | - Peter F Svider
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Hani Rayess
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Anthony Sheyn
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA; Division of Pediatric Otolaryngology, LeBonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Adam J Folbe
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, NJ, USA; Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Giancarlo Zuliani
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA; Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Michael A Carron
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA; Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
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Choudhry AJ, Haddad NN, Rivera M, Morris DS, Zietlow SP, Schiller HJ, Jenkins DH, Chowdhury NM, Zielinski MD. Medical malpractice in the management of small bowel obstruction: A 33-year review of case law. Surgery 2016; 160:1017-1027. [DOI: 10.1016/j.surg.2016.06.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 06/10/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
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Rayess HM, Gupta A, Svider PF, Raza SN, Shkoukani M, Zuliani GF, Carron MA. A critical analysis of melanoma malpractice litigation: Should we biopsy everything? Laryngoscope 2016; 127:134-139. [DOI: 10.1002/lary.26167] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 05/26/2016] [Accepted: 06/06/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Hani M. Rayess
- Department of Otolaryngology-Head and Neck Surgery; Wayne State University School of Medicine; Detroit Michigan U.S.A
| | - Amar Gupta
- Department of Otolaryngology-Head and Neck Surgery; Wayne State University School of Medicine; Detroit Michigan U.S.A
| | - Peter F. Svider
- Department of Otolaryngology-Head and Neck Surgery; Wayne State University School of Medicine; Detroit Michigan U.S.A
| | - S. Naweed Raza
- Department of Otolaryngology-Head and Neck Surgery; Wayne State University School of Medicine; Detroit Michigan U.S.A
- Barbara Ann Karmanos Cancer Institute; Detroit Michigan U.S.A
| | - Mahdi Shkoukani
- Department of Otolaryngology-Head and Neck Surgery; Wayne State University School of Medicine; Detroit Michigan U.S.A
- Division of Facial Plastic and Reconstructive Surgery; Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine; Detroit Michigan U.S.A
- Barbara Ann Karmanos Cancer Institute; Detroit Michigan U.S.A
- Section of Otolaryngology; Department of Surgery, John D. Dingell VA Medical Center; Detroit Michigan U.S.A
| | - Giancarlo F. Zuliani
- Department of Otolaryngology-Head and Neck Surgery; Wayne State University School of Medicine; Detroit Michigan U.S.A
- Division of Facial Plastic and Reconstructive Surgery; Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine; Detroit Michigan U.S.A
- Section of Otolaryngology; Department of Surgery, John D. Dingell VA Medical Center; Detroit Michigan U.S.A
| | - Michael A. Carron
- Department of Otolaryngology-Head and Neck Surgery; Wayne State University School of Medicine; Detroit Michigan U.S.A
- Division of Facial Plastic and Reconstructive Surgery; Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine; Detroit Michigan U.S.A
- Section of Otolaryngology; Department of Surgery, John D. Dingell VA Medical Center; Detroit Michigan U.S.A
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