Patient Safety in Internal Medicine

AbstractHospital Internal Medicine (IM) is the branch of medicine that deals with the diagnosis and non-surgical treatment of diseases, providing the comprehensive care in the office and in the hospital, managing both common and complex illnesses of adolescents, adults, and the elderly. IM is a key ward for Health National Services. In Italy, for example, about 17.3% of acute patients are discharged from the IM departments. After the epidemiological transition to chronic/degenerative diseases, patients admitted to hospital are often poly-pathological and so requiring a global approach as in IM. As such transition was not associated—with rare exceptions—to hospital re-organization of beds and workforce, IM wards are often overcrowded, burdened by off-wards patients and subjected to high turnover and discharge pressure. All these factors contribute to amplify some traditional clinical risks for patients and health operators. The aim of our review is to describe several potential errors and their prevention strategies, which should be implemented by physicians, nurses, and other healthcare professionals working in IM wards

Alterations in glucocorticoid inducible RNAs in the limbic system of learned helpless rats

Glucocorticoids (GC) have an important effect on mood in humans and influence learned helplessness, an escape avoidance paradigm that is considered one of the best animal models of depression. A strong genetic component underlies the development of learned helplessness as shown by the emergence of a line of highly vulnerable rats (LH strain) through selective inbreeding. In addition, hormonal factors play a role. Adrenalectomy (adx) for example is known to increase the vulnerability to acquire learned helplessness, an effect that is reversed by glucocorticoids (GC). Since GC function primarily by modulating gene expression, hormone mediated alterations in mRNAs expressed in the brain may be important in the development of an adequate escape avoidance response. Conversely, we postulate that the deficit in escape avoidance behavior exhibited by the LH strain may be associated with an alteration in GC-mediated gene expression in the brain. To test this hypothesis, we analyzed GC-responsive mRNAs that are expressed in the hippocampus. Control Sprague-Dawley (SD) rats showed consistent alterations in mRNAs that are modulated by GC, such as type II GC receptor (GR) and metallothionein-1 (MT-1). Under our experimental conditions, both GR and MT-1 mRNA are significantly increased in the hippocampus of hormone-treated SD rats. An increase in hypothalamic GR mRNA was also observed. However, under the same experimental conditions, LH rats showed more selective hormone induced changes since GC had no effect on hypothalamic and hippocampal GR mRNA whereas a significant increase in MT-1 mRNA was observed

Venous Thromboembolism (VTE) Education Preferences Amongst Physicians and Patients: A Qualitative Needs Assessment

Abstract Introduction: Venous thromboembolism (VTE) is the leading cause of preventable deaths in hospitalized patients. Prior studies have demonstrated that increasing patient education about VTE increases medication adherence. Thus, standardizing VTE education is an important priority in optimizing patient care. In this regard, online education offers unique advantages as it can be accessed by patients anywhere and anytime. However, an effective VTE educational tool remains elusive as little research has been done to determine what information patients should know or how such information can be delivered most effectively. We performed a qualitative study of hematologists and VTE patients to understand these issues, with the goal of utilizing this information to create an online educational tool for VTE that addresses the needs of both clinicians and patients. Methods: We conducted semi-structured interviews with physicians in the Section of Hematology at Yale School of Medicine (YSM) and VTE patients in the outpatient Benign Hematology Clinic at Yale Cancer Hospital. Adult patients with a pulmonary embolism or deep venous thrombosis, who were on or off anticoagulation, and who were seen in the outpatient clinic either as new patients or for follow-up visits were all included. Providers were asked about what strategies work best when communicating to patients and important aspects of VTE they felt patients should know. Patients were asked about their understanding of VTE and how an educational tool would best address their concerns. All interviews were audio recorded and transcribed. Data were analyzed with grounded theory, and each transcript was double-coded until thematic saturation was achieved. Results: Five physicians participated in the study: one with a focus in benign hematology, three with a focus in benign and malignant hematology, and one who had been a private practice hematology/oncology provider and then transitioned into a clinical appointment on the YSM Hematology faculty. Qualitative analysis from the physician interviews revealed important themes. In particular, physicians believed that an online resource for VTE should: 1) provide visual animation to facilitate conceptual understanding; 2) be readily accessible and as concise as possible; and 3) follow a standardized format that addresses classification of VTE (provoked vs. unprovoked), signs and symptoms of VTE, treatment options, and long-term management. Eight patients were interviewed for the study, 4 with a first episode of VTE and 4 with recurrent VTE. Of these, 7 were on anticoagulation and 1 was not. Most patients indicated that their major source of online health education was through websites - most notably "WebMD." Patients identified websites as helpful in providing background information, but felt that websites were limited in their ability to provide personalized patient-based recommendations. Many also found website text lengthy and felt that concepts could be better conveyed if explained visually in a concise manner. Conclusion: Based on the physician and patient interviews, an optimal online educational tool about VTE should address the pathophysiology, natural history, management, recurrence risk, and prevention of VTE, in a concise and personalized manner, utilizing visual stimuli. We plan on synthesizing this information to create a 5-10 minute animated video about VTE that addresses all of these issues; we then hope to study the efficacy of the video through a randomized control trial. Disclosures No relevant conflicts of interest to declare. </jats:sec

Comparison of traditional instruction versus nontraditional learning to improve trainee knowledge of urine culture practices in catheterized patients

Abstract We surveyed trainees about their urine culture practices and assessed the impact of an educational intervention delivered electronically and in person. Trainee scores improved across all levels of training and across all questions on the postintervention survey, but there was no difference in scores by mode of education (P = .91).</jats:p