Hospitals

Background: Adverse events are a prevalent occurrence across pediatric healthcare environments, and patient safety is intricately tied to nursing errors due to nurses’ consistent presence and interaction with patients, which surpasses that of any other healthcare professional. This research sought to explore the factors influencing errors as perceived by pediatric nurses in Greek hospital settings. Methods: Clinical pediatric nurses voluntarily and anonymously completed a specialized structured survey, utilizing the Taxonomy of Error, Root Cause Analysis, and Practice-responsibility (TERCAP) tool, which delineates the circumstances surrounding errors occurring during clinical practice. Results: Among the participants employed in the pediatric department, 80.8% (n = 84) reported experiencing an error at their workplace. Notably, in 48.7% (n = 38) of these instances, the error was attributed to themselves (personal responsibility), while in 78.9% (n = 56) of cases, it was linked to errors committed by other colleagues in the clinic. As reported by participants in pediatric departments, the primary factors contributing to potential error occurrence include the absence or inadequacy of orientation and training for new staff (43.2%), the absence of a standardized protocol for resolving disagreements (39%), insufficient ongoing training (38.3%), and breakdowns in interdisciplinary communication (21%). Conclusions: By classifying errors based on various criteria such as outcomes, processes, cognitive reasoning, ethical considerations, and importance, this study presents a holistic framework for examining pediatric nurses’ errors from diverse perspectives. Through this classification approach, the study establishes a foundation for tailored interventions targeting particular aspects of errors and their root causes in pediatric departments. Full article

Introduction: With the passage of the Physician Payment Sunshine Act, there has been increased transparency regarding the industrial financial relations that physicians have. Orthopedic surgeons have been highly studied in this domain with approximately 50% of all orthopedic surgeons engaging in industrial financial relationships. Furthermore, an increasing number of orthopedic surgeons are seeking fellowship training with pediatric fellowship programs gaining popularity in recent years. The purpose of this study is to evaluate the impact various pediatric orthopedic fellowship programs have on industry earnings and academic productivity. Methods: Pediatric orthopedic fellowship programs were identified via the Orthopedic Society of North America (POSNA) website. Information on individual fellowship programs was obtained from their respective websites. Academic productivity was measured via an aggregate of all employed physicians’ H-index at a specific fellowship as found on the Scopus website. The Open Payments Database (OPD) website was used to assess lifetime industry earnings. Other variables such as Newsweek or Doximity ranking were taken directly from relevant websites. Statistical analysis was performed using a Kruskal–Wallis test with Bonferroni correction and Mann–Whitney U-test. Results: A total of 43 pediatric orthopedic surgery fellowships in the United States were identified with a total of 392 physicians as fellowship faculty. Complete OPD and H-index information were available for 336 of those physicians (85.7%). On average, there were 7.81 ± 5.18 physicians and 1.56 ± 0.93 fellows per program. The mean combined physician H-index was 117.23 ± 122.51, and the mean combined physician lifetime supplemental earnings in dollars was $646,684.37 ± $1,159,507.17. There was no significant relationship between region of pediatric orthopedic fellowship, Newsweek ranking of affiliated hospital, Doximity ranking of affiliated hospital, presence of MBA program, type of program (public, private, mixed), and the lifetime industry earnings or academic productivity of program graduates. Conclusions: Despite the observed lack of statistical significance, there were clear trends observed with fellowship programs in the northeast and west coast regions being the highest earning and fellowship programs with top 10 Newsweek ranking of affiliated hospital having by far the greatest industry earnings. Sample size limitations likely prevented the detection of statistical significance. Future studies should examine if any relation exists when accounting for type of industry payment received and case volume per fellowship program. Full article

Post-injury confusional state is a common phenomenon following acquired brain injury. A multi-faceted approach for decreasing confusion is recommended, but there is a paucity of research related to non-pharmacological management. The main objective was to present a conceptual model of multi-faceted approaches for confusion, and secondly to investigate the rehabilitation outcome following these approaches. The setting is a specialized ward for rehabilitation of patients with severe cognitive difficulties following acquired brain injury. The conceptual model encompasses neurobehavioral strategies, pharmacological treatment, engagement in meaningful occupations, next of kin involvement, organizational demands, the physical environment, along with differential diagnostics. Patient cases are provided to illustrate the impact of each approach. A total of 141 of 281 patients were in a confusional state at admission. At discharge, 62% had emerged from the confusional state. Patients in a confusional state due to traumatic brain injury and subarachnoid hemorrhage had clinically important differences of >22 points in the functional independence measure from admission to discharge, following rehabilitation efforts based on the conceptual model. No clinically important difference was seen in patients with non-SAH stroke and patients with other types of brain injuries. The proposed conceptual model should be further evaluated in complex intervention studies. Full article

[Background] Intermediate care is a limited-time service founded on patient-centered care (PCC) that ensures continuity and quality of care during the transition between home and acute care services, promotes recovery, and restores independence and confidence. In Japan, systematic education on intermediate care for care providers is lacking. [Method] The present study explored the relationship between a Japanese scale used to evaluate individualized discharge support skills, a Japanese version of a tool for evaluating intermediate care based on PCC, and a tool that measures the shared decision making of care providers, which is the pinnacle of PCC. [Results] Clear correlations were found between the concepts evaluated using these three tools. Some concepts were not correlated between the Japanese scale that evaluated individualized discharge support skills and intermediate care based on PCC. [Conclusions] Elucidating the perspectives that help expand discharge care to intermediate care based on PCC will contribute to future education on intermediate care for Japanese care providers and to enriching patient-centered intermediate care. Full article

Neurology holds a unique perspective that embodies the art of capturing a patient’s story. Despite medical advancements, many neurological conditions leave patients permanently impaired. This sudden loss of independence can be demoralizing and, in most cases, directly changes a person’s identity. It is therefore a necessary part of a neurologist’s trade to know their patient’s history—their story. Their tales reveal intimate details of their personality changes, memory loss, sensory deprivation, and movement disorders. A true neurologist is a person that remains vulnerable through their willingness to take a history—the story of their patient—and remain curious, vulnerable, and compassionate through their journey to heal and comfort the patient. To understand the patient’s illness experience in neurology, the underlying themes of patient recovery (compassion, determination, and patience) are explored with regard to the neurological patient’s experience. These themes are then expanded to include the neurology patient’s mental perceptions of themselves, and their illness’ influences over their identity, recovery, and daily life. In addition to the patient’s experience, the neurologist’s awareness and emotional response to the patient’s illness experience can provide an opportunity to develop a strong therapeutic bond with their patient and improve patient outcomes. Given that their neurological impairment causes a loss of independence and control over their identity and self-worth, neurologists can incorporate the patient’s experience into their management and treatment, to better address their emotional and spiritual needs as they come to terms with their identity. Full article

This essay focuses on so-called obstetric violence, i.e., the medical malpractice consisting of disrespect and/or abuses to the detriment of women during their labor or when they give birth, as well as during health care services concerning the sexual and reproductive sphere. The main goal is to start a debate on a topic already considered by foreign lawmakers, also for punishment purposes. After an empirical-criminological survey of the cases and the misconduct to be labelled as “obstetric violence”, this essay analyses the legal tools available in Italy. From a law reform perspective, the author reflects on the (non-criminal) strategies to prevent distortions of the doctor–patient relationship as well as on the harm to women’s self-determination and dignity, particularly in respect of the rules on informed consent. Full article