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Effective communication is essential between health professionals during surgical procedures for delivery of safe patient care. The influence of noise on communication during critical moments of surgery and on communication failures is unclear.
To examine communication events among health professionals in the operating room and investigate the influence of noise on communication.
Non-participatory observations were undertaken of communication between health professionals during surgical procedures while simultaneously measuring sound pressure levels. Audio visual recording was used to document communication events, ensuring data accuracy. A generalised linear mixed model was used to examine relationships between various explanatory variables and the presence of at least one communication failure. The STROBE checklist guided the reporting of this paper.
A representative range of procedures was observed from diverse surgical specialties (N = 80). Observations comprised 2274 communication events; communication failures were observed in 24% and repeated communication was observed in 25% of all communication events. The mean maximum sound pressure levels were 64.9 dB[A] for communication events, 64.5 dB[A] for communication failures and 65.5 dB[A] for repeats. The type of surgical procedure, the emergence from anaesthesia compared to other phases of surgery, communication related to the surgical safety checklist, communication related to the surgical count, the presence of multitasking, and the use of surgical facemasks, were associated with the presence of at least one communication failure.
This research identified the inherent risks and occurrence of communication failure in noisy operating room environments where health professionals are undertaking complex cognitive tasks and where effective communication is essential to ensure patient safety.
This study did not include patient or public involvement in its design, conduct, or reporting.
A comprehensive skincare regimen involves cleansing, moisturising, and using skin barrier protectants. Cyanoacrylate-based protectants safeguard vulnerable skin from damage caused by moisture, friction, and shear. This research involved two ex vivo and two clinical studies comparing the wear duration and wash-off resistance of a 100% cyanoacrylate and a solvent-cyanoacrylate mixture. Effectiveness was assessed using an ex vivo porcine skin model simulating urinary incontinence, evaluated with Lucifer yellow dye penetration and Corneometry, and a clinical model using Corneometry. Two single-blind clinical studies measured skin surface electrical capacitance in healthy volunteers. Study 1 (n = 42) evaluated the wear duration over 8 days, while Study 2 (n = 52) examined wash-off resistance after nine washes with various cleansers. Ex vivo results showed that both products were effective under repeated moisture and abrasion conditions, with the 100% cyanoacrylate outperforming the solvent-cyanoacrylate mixture. In clinical studies, both products maintained barrier protection throughout Study 1 (p < 0.007) and none of the cleansers significantly degraded either product in Study 2. In conclusion, the 100% cyanoacrylate provided superior protection compared to the solvent-cyanoacrylate mixture. Both products demonstrated comparable wear duration and wash-off resistance in clinical studies, but the 100% cyanoacrylate was more effective in ex vivo testing under harsh conditions.
To compare primary care for depression among patients detected in the first 21 months of the SARS-CoV-2 pandemic to patients detected pre-pandemic, and examine whether depression care was associated with patient characteristics.
Retrospective pre–post study using de-identified data from electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN).
Primary care clinics enrolled in CPCSSN from 1 January 2018 to 31 December 2021.
Patients with a valid CPCSSN case definition of depression detected between 01 January 2018 and 31 December 2021 were included in the cohort and categorised by detection date (pre-pandemic or during Canadian pandemic waves).
Primary care encounters, psychotropic prescriptions and selective serotonin reuptake inhibitor (SSRI) prescriptions were observed at 3 and 12 months post-detection. Multivariable regression evaluated associations between patients’ depression detection timing and depression care, adjusting for age, sex, rurality, neighbourhood deprivation quintile, province, number of observable comorbidities and pre-detection psychotropic use.
91 453 patients with depression were identified, of whom 53% were detected pre-pandemic. Patients detected during the pandemic were younger and less comorbid than those detected pre-pandemic. Proportions of patients with any encounter, psychotropic prescriptions and SSRI prescriptions were higher for patients detected during every pandemic wave compared with patients detected pre-pandemic. The adjusted incidence rate ratios (aIRRs) of number of encounters (aIRR=1.15; 95% CI 1.13 to 1.17), psychotropics (aIRR=1.11, 95% CI 1.09 to 1.13) and SSRIs prescribed (aIRR=1.12; 95% CI 1.10 to 1.15) within 3 months of detection were higher among patients detected during the first pandemic wave compared with those detected pre-pandemic. Socio-demographic characteristics had weaker associations with outcomes compared with timing of detection. Results were similar within 12 months of detection.
Overall, primary care for depression was maintained during the pandemic despite challenging circumstances. Increases in paediatric encounter rates and increased prescribing in younger adults warrant further investigation to understand the factors driving these patterns.
ClinicalTrials.gov NCT05813652.
Over 777 million COVID-19 infections have occurred globally, with data suggesting that 10%–20% of those infected develop Long COVID. Fatigue is one of the most common and disabling symptoms of Long COVID. We aim to assess the feasibility and safety of a new, remotely delivered, multimodal rehabilitation intervention, paced to prevent post-exertional malaise (PEM), to support the conduct of a future, definitive randomised trial.
We will conduct a randomised, two-arm feasibility trial (COVIDEx intervention vs usual care). Sixty participants with Long COVID will be recruited and randomised prior to giving informed consent under a modified Zelen design using 1:1 allocation with random permuted blocks via central randomisation to receive either the COVIDEx intervention or usual care. The 50-minute, remotely delivered, COVIDEx intervention will occur twice weekly for 8 weeks. All participants will wear a non-invasive device throughout their entire study participation, to track heart rate, blood oxygen saturation, steps, sleep and monitor PEM. The primary feasibility objectives will be recruitment rates, intervention fidelity, adherence, acceptability (intervention and design), retention, blinding success and outcome completeness. Secondary objectives will include refined estimates for the standard deviation and correlation between baseline and follow-up measurements of fatigue. Feasibility and clinical outcomes will be collected at baseline, 4, 8, 12 and 24 weeks. Qualitative interviews with participants and physiotherapists will explore intervention acceptability and barriers/facilitators.
Ethical approval for this study was obtained by the Western University Health Sciences Research Ethics Board (REB# 123902). Dissemination plans include sharing of trial findings at conferences and through open access publications and patient/community channels.
To explore healthcare professionals', patients', and family members' experiences of managing regular medications across the perioperative pathway in a specialist cancer hospital in Melbourne.
An exploratory qualitative study using a descriptive-interpretive approach.
Interviews were conducted with 11 patients and seven family members, and focus groups with 10 anaesthetists, seven surgeons, four nurses, and 10 pharmacists (N = 49) between October 2024 and April 2025. Transcripts were analysed using Braun and Clarke's reflexive thematic approach and mapped into the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 human factors framework.
Three interrelated themes were constructed: (1) Work system elements shaping perioperative medication management, encompassing medication and surgical contexts, documentation gaps, reliable medication information, communication infrastructures, roles and responsibilities, and perioperative area resources; (2) Processes influencing medication management practice, characterised by continuity of care at transition points and flagging processes, interdisciplinary collaboration and role interpretation in medication management, patient involvement, family member involvement, and healthcare professional perspectives; and (3) Outcomes of medication management, including patient and organisational outcomes, such as workflow inefficiencies, procedure cancellations, and unplanned readmissions.
Findings indicated that addressing the complexity of perioperative medication safety demands coordinated contributions across multiple professional disciplines. Strengthening interdisciplinary collaboration, clarifying shared responsibilities, embedding structured reconciliation processes at transitions of care, standardizing communication protocols, and involving patients and families are all critical strategies.
This study highlights the need for interdisciplinary coordination and clear role definitions, with nurses as the key contributor, to support collaborative medication decisions in perioperative cancer care.
This study explored challenges in managing regular medications during cancer surgery, offering insights to guide safer practices for perioperative teams, patients, and families in cancer care settings.
COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines.
None.
Despite low sensitivity and implementation challenges, the tuberculin skin test (TST) remains the standard-of-care tuberculosis (TB) infection test in Mexico. Interferon gamma release assays (IGRA) may overcome TST-related challenges. Within the confines of the local programmatic setting, this cross-sectional study evaluated the prevalence of TB infection (TBI) and concordance of TST and IGRA in three high-risk populations in Mexicali, Baja California, Mexico.
Household contacts (HHC) of individuals with TB, people who use drugs (PWUD), people deprived of liberty (PDL) and prison employees underwent evaluation for TBI using TST and QIAreach, a novel IGRA. Prevalence of infection, concordance of test results and reactivity trends of time-to-results (TTR) by TST-induration size were assessed.
In total, 214 of 411 (52.07%) people who had TST and 269 of 460 (58.48%) people who had IGRA tested positive for TBI. Frequency of infection varied across risk groups (HHC 29 (29.6%); PWUD 67 (70.53%); PDL 111 (56.06%) and prison employees 7 (35.0%), p20 mm, p=0.05).
All risk groups had a high frequency of TBI, necessitating locally tailored guidelines for screening, treatment and management of TBI to optimise care for vulnerable populations.
Primary care electronic health records provide a rich source of information for inequalities research. However, the reliability and validity of the research derived from these records depend on the completeness and resolution of the codelists (ie, collections of medical terms/codes) used to identify populations of interest. The aim of this project was to develop comprehensive codelists for identifying people from ethnic minority groups, people with learning disabilities (LDs), people with severe mental illness (SMI) and people who are transgender.
We followed a three-stage process to define and extract relevant codelists. First, groups of interest were defined a priori. Next, relevant clinical codes, relating to the groups, were identified by searching Clinical Practice Research Datalink (CPRD) publications, codelist repositories and the CPRD Code Browser. Relevant codelists were extracted and merged according to group, and duplicates were removed. Finally, the remaining codes were reviewed by two general practitioners (GPs).
The curated codelists were compared using a representative sample in the UK. The frequencies of individuals identified using the curated codelists were assessed and compared with widely used alternative codelists.
Comprehensiveness was assessed in a representative CPRD population of 10 966 759 people.
After removal of duplicates and GP review, codelists were finalised with 325 unique codes for ethnicity, 558 for LD, 499 for SMI and 38 for transgender. Compared with comparator codelists, an additional 48 017 (76.6%), 52 953 (68.9%) and 508 (36.9%) people with LD, SMI or transgender code were identified. The proportions identified for ethnicity, meanwhile, were consistent with expectations for the UK (eg, 6.50% Asian, 2.66% black and 1.44% mixed).
The curated codelists are more sensitive than those widely used in practice and research. Discrepancies between national estimates and primary care records suggest potential record/retention issues. Resolving these requires further investigation and could lead to improved data quality for research.
We calculate positive predictive values (PPVs) of patients presenting with unexpected weight loss (UWL) being diagnosed with cancer within 6 months, using data from a population of Australian primary care patients to replicate results from a previous UK study.
A diagnostic accuracy study involving calculation of the PPV for any cancer using retrospective data from routinely collected electronic healthcare records. The index date is defined as the first recorded UWL presentation and the reference standard is cancer diagnosis within 6 months of the index date.
This study uses primary care data from the Patron primary care database, linked to hospital admissions data and the Victorian Cancer Registry. We include only patients who presented to their General Practitioners (GPs) at least once between 1 July 2007 and 1 February 2022.
Patients were included if they were at least 18 years of age at the index date, had no previous diagnosis of cancer or previous weight loss intervention, including being prescribed medications for weight loss. 13 306 patients out of a primary care population of 1 791 051 patients were identified that met the eligibility criteria.
When stratified by age, sex and smoking status, we found PPVs lower than those derived in a previous UK primary care study, though still above 3% for male non-smokers over 60, female smokers over 70 and all males over 70. Patients from ages 60–79 with at least one abnormal blood test result had PPVs consistently above 3%, while overall, patients with abnormal blood test results have PPVs of up to 35%.
We confirmed that many PPVs, while consistently below those derived in the UK study, are above clinically significant thresholds and increasing with age and the number of different abnormal blood test results.
Acknowledging equality, diversity and inclusion (EDI) in research is not only a moral imperative but also an important step in avoiding bias and ensuring generalisability of results. This protocol describes the development of STAndards for ReporTing EDI (START-EDI) in research, which will provide a set of minimum standards to help researchers improve their consistency, completeness and transparency in EDI reporting. We anticipate that these guidelines will benefit authors, reviewers, editors, funding organisations, healthcare providers, patients and the public.
To create START-EDI reporting guidelines, the following five stages are proposed: (i) establish a diverse, multidisciplinary Steering Committee that will lead and coordinate guideline development; (ii) a systematic review to identify the essential principles and methodological approaches for EDI to generate preliminary checklist items; (iii) conduct an international Delphi process to reach a consensus on the checklist items; (iv) finalise the reporting guidelines and create a separate explanation and elaboration document; and (v) broad dissemination and implementation of START-EDI guidelines. We will work with patient and public involvement representatives and under-served groups in research throughout the project stages.
The study has received ethical approval from the Imperial College London Research Ethics Committee (study ID: 7592283). The reporting guidelines will be published in open access peer-reviewed publications and presented in international conferences, and disseminated through community networks and forums.
The project is pre-registered within the Open Science Framework (https://osf.io/8udbq/) and the Enhancing the Quality and Transparency of Health Research Network.
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