Patient participation in patient safety still missing: Patient safety experts' views

The aim of this study was to elicit patient safety experts' views of patient participation in promoting patient safety. Data were collected between September and December in 2014 via an electronic semi‐structured questionnaire and interviews with Finnish patient safety experts (n = 21), then analysed using inductive content analysis. Patient safety experts regarded patients as having a crucial role in promoting patient safety. They generally deemed the level of patient safety as ‘acceptable’ in their organizations, but reported that patient participation in their own safety varied, and did not always meet national standards. Management of patient safety incidents differed between organizations. Experts also suggested that patient safety training should be increased in both basic and continuing education programmes for healthcare professionals. Patient participation in patient safety is still lacking in clinical practice and systematic actions are needed to create a safety culture in which patients are seen as equal partners in the promotion of high‐quality and safe care.     

Integrating an evidenced-based research intervention in the discharge of mental health clients

The purpose of this Canadian qualitative study was to explore the experiences of clinical staff who implemented a research intervention: the Transitional Discharge Model (TDM). The TDM provided mental health clients who were hospitalized with peer support and an inpatient staff member to bridge the therapeutic transitioning from hospital staff to the community care provider. Staff from three tertiary care mental health facilities in Canada identified their learning needs in regard to providing the intervention. An educational program was developed and delivered to the clinical staff to support and facilitate the implementation of the new TDM. The extent of the utilization of knowledge and implementation of the TDM varied across the three tertiary care mental health facilities. Focus groups (N=49) with clinical staff were conducted to explore various factors related to the training process as well as the challenges and benefits of implementing the TDM. Data were analyzed using Leininger's Phases of Ethnonursing Qualitative Data Analysis [Leininger, M. (2002). The theory of culture care and the ethnonursing research method. In M. Leininger & M. McFarland (eds.), Transcultural nursing: Concepts, theories, research, and practice (3rd ed.). New York: McGraw-Hill]. Findings revealed that clinical staff experienced challenges in roles and responsibilities, relationships with others, values and beliefs of clients, staff and community, resources, and the processes of care. From the findings, strategies were identified to support the integration of knowledge about the TDM into practice and to increase clinical staff's skills in implementing research interventions. These included support from others, as well as support of practice, policy, and education.     

Do clinically relevant transthoracic defibrillation energies cause myocardial damage and dysfunction?

Sufficiently strong defibrillation shocks will cause temporary or permanent damage to the heart. Weak defibrillation shocks do not cause any damage to the heart but also do not defibrillate. A relevant and practical question is what range of shock energies is most likely to defibrillate while not causing damage to the heart. This question is most difficult to answer in the pre-hospital defibrillation setting where the patients' size and shape vary, placement of the defibrillation patches vary, and the etiology of their arrhythmia varies. Unlike internal defibrillators, which are tested at implantation, efficacy of an external defibrillator is determined only once, when it is most needed. This review discusses shock damage and dysfunction caused by monophasic waveforms as well as biphasic waveforms. Evidence is presented suggesting that for perfused hearts, the threshold for damage is well above any shock size delivered clinically. For non-perfused hearts, both in humans and animals, evidence is presented that monophasic shocks of up to 5 J/kg do not cause any more cardiac damage/dysfunction than that associated with smaller shocks and that much of this damage is caused by the ischemic period itself rather than the shock. Although many patients can be defibrillated with 150 J (2.2 J/kg) biphasic shocks, some patients may require biphasic shocks up to 360 J (5 J/kg) to be defibrillated. Studies still need to be performed comparing the efficacy and damaging effects of 360 J biphasic shocks to 150 J biphasic shocks. Until those studies are completed, it seems reasonable to use the same 360 J (5 J/kg) energy limit for biphasic shocks as for monophasic shocks.     

Using the Internet to Recruit Rural MSM for HIV Risk Assessment: Sampling Issues

The Internet is an emerging research tool that may be useful for contacting and working with rural men who have sex with men (MSM). Little is known about HIV risks for rural men and Internet methodological issues are only beginning to be examined. Internet versus conventionally recruited samples have shown both similarities and differences in their demographic characteristics. In this study, rural MSM from three sizes of town were recruited by two methods: conventional (e.g. face-to-face/snowball) or Internet. After stratifying for size of city, demographic characteristics of the two groups were similar. Both groups had ready access to the Internet. Patterns of sexual risk were similar across the city sizes but varied by recruitment approach, with the Internet group presenting a somewhat higher HIV sexual risk profile. Overall, these findings suggest the Internet provides a useful and low cost approach to recruiting and assessing HIV sexual risks for rural White MSM. Further research is needed on methods for recruiting rural minority MSM.     

Endoscopic gastrojejunostomy with survival in a porcine model

BACKGROUND: We have previously reported the feasibility and the safety of an endoscopic transgastric approach to the peritoneal cavity in a porcine model. We now report successful performance of endoscopic gastrojejunostomy with survival. METHODS: All procedures were performed on 50-kg pigs, with the pigs under general anesthesia, in aseptic conditions with sterilized endoscopes and accessories. The stomach was irrigated with antibiotic solution, and a gastric incision was performed with a needle-knife and a sphincterotome. A standard upper endoscope was advanced through a sterile overtube into the peritoneal cavity. A loop of jejunum was identified, was retracted into the stomach, and was secured with sutures while using a prototype endoscopic suturing device. An incision was made into the jejunal loop with a needle-knife, and the filet-opened ends of the jejunal wall were secured to the gastric wall with a second line of sutures, completing the gastrojejunostomy. OBSERVATIONS: Two pigs survived for 2 weeks. Endoscopy and a radiographic contrast study performed after gastrojejunostomy revealed a patent anastomosis with normal-appearing gastric and jejunal mucosa. Postmortem examination demonstrated a well-healed anastomosis without infection or adhesions. CONCLUSIONS: The endoscopic transgastric approach to create a gastrojejunostomy is technically feasible and can be performed, with survival, in a porcine model.     

Effects of PACAP on Mitochondrial Apoptotic Pathways and Cytokine Expression in Rats Subjected to Renal Ischemia/Reperfusion

Pituitary adenylate cyclase activating polypeptide (PACAP) is a neuropeptide with highly efficient cytoprotective actions. Its neuroprotective effects are well-known, but PACAP is able to exert similar actions in non-neuronal cells. Recently, we have shown that PACAP prolongs renal ischemic time, decreases mortality, and attenuates tubular degeneration in a rat model of renal ischemia/reperfusion, but the mechanism of renoprotection is not yet known. Therefore, the aim of the present study was to obtain further insight into the renoprotective effects of PACAP by examining its direct effects of PACAP on mitochondrial permeability transition in vitro and on the expression of the anti-apoptotic Bcl-2 and cytokines/chemokines in kidney tissues following 45 and 60 min renal ischemia and reperfusion in vivo. We found that PACAP did not have any direct effect on mitochondrial permeability transition. Cytokine array revealed that the expression of a few cytokines/chemokines was strongly increased after ischemia/reperfusion, which was ameliorated by PACAP treatment. Furthermore, in rats subjected to renal ischemia, PACAP treatment counteracted the ischemia/reperfusion-induced decrease of the anti-apoptotic Bcl-2, both after 45 and 60 min ischemia, as analyzed by Western blot. In summary, we showed that PACAP could attenuate tissue injury involving both anti-inflammatory and anti-apoptotic effects, but not directly acting on mitochondrial permeability transition.