Sex and gender-based analysis and diversity metric reporting in acute care trials published in high-impact journals: a systematic review.

OBJECTIVE: To characterise sex and gender-based analysis (SGBA) and diversity metric reporting, representation of female/women participants in acute care trials and temporal changes in reporting before and after publication of the 2016 Sex and Gender Equity in Research guideline. DESIGN: Systematic review. DATA SOURCES: We searched MEDLINE for trials published in five leading medical journals in 2014, 2018 and 2020. STUDY SELECTION: Trials that enrolled acutely ill adults, compared two or more interventions and reported at least one clinical outcome. DATA ABSTRACTION AND SYNTHESIS: 4 reviewers screened citations and 22 reviewers abstracted data, in duplicate. We compared reporting differences between intensive care unit (ICU) and cardiology trials. RESULTS: We included 88 trials (75 (85.2%) ICU and 13 (14.8%) cardiology) (n=111 428; 38 140 (34.2%) females/women). Of 23 (26.1%) trials that reported an SGBA, most used a forest plot (22 (95.7%)), were prespecified (21 (91.3%)) and reported a sex-by-intervention interaction with a significance test (19 (82.6%)). Discordant sex and gender terminology were found between headings and subheadings within baseline characteristics tables (17/32 (53.1%)) and between baseline characteristics tables and SGBA (4/23 (17.4%)). Only 25 acute care trials (28.4%) reported race or ethnicity. Participants were predominantly white (78.8%) and male/men (65.8%). No trial reported gendered-social factors. SGBA reporting and female/women representation did not improve temporally. Compared with ICU trials, cardiology trials reported significantly more SGBA (15/75 (20%) vs 8/13 (61.5%) p=0.005). CONCLUSIONS: Acute care trials in leading medical journals infrequently included SGBA, female/women and non-white trial participants, reported race or ethnicity and never reported gender-related factors. Substantial opportunity exists to improve SGBA and diversity metric reporting and recruitment of female/women participants in acute care trials. PROSPERO REGISTRATION NUMBER: CRD42022282565.

Mitigating errors caused by interruptions during medication verification and administration: interventions in a simulated ambulatory chemotherapy setting.

BACKGROUND: Nurses are frequently interrupted during medication verification and administration; however, few interventions exist to mitigate resulting errors, and the impact of these interventions on medication safety is poorly understood. OBJECTIVE: The study objectives were to (A) assess the effects of interruptions on medication verification and administration errors, and (B) design and test the effectiveness of targeted interventions at reducing these errors. METHODS: The study focused on medication verification and administration in an ambulatory chemotherapy setting. A simulation laboratory experiment was conducted to determine interruption-related error rates during specific medication verification and administration tasks. Interventions to reduce these errors were developed through a participatory design process, and their error reduction effectiveness was assessed through a postintervention experiment. RESULTS: Significantly more nurses committed medication errors when interrupted than when uninterrupted. With use of interventions when interrupted, significantly fewer nurses made errors in verifying medication volumes contained in syringes (16/18; 89% preintervention error rate vs 11/19; 58% postintervention error rate; p=0.038; Fisher's exact test) and programmed in ambulatory pumps (17/18; 94% preintervention vs 11/19; 58% postintervention; p=0.012). The rate of error commission significantly decreased with use of interventions when interrupted during intravenous push (16/18; 89% preintervention vs 6/19; 32% postintervention; p=0.017) and pump programming (7/18; 39% preintervention vs 1/19; 5% postintervention; p=0.017). No statistically significant differences were observed for other medication verification tasks. CONCLUSIONS: Interruptions can lead to medication verification and administration errors. Interventions were highly effective at reducing unanticipated errors of commission in medication administration tasks, but showed mixed effectiveness at reducing predictable errors of detection in medication verification tasks. These findings can be generalised and adapted to mitigate interruption-related errors in other settings where medication verification and administration are required.

Interruptions during the delivery of high-risk medications.

OBJECTIVE: The goal of this study was to assess the nature and frequency of interruptions during medication administration and the interruptions' effects on task efficiency to guide healthcare managers/executives in improving patient safety and staff productivity. BACKGROUND: Interruptions have been identified as causal factors in medication administration errors. Research, however, is needed to assess the nature and frequency of interruptions throughout specific stages of the medication administration process and to develop mitigation interventions. METHOD: A direct observation study was conducted to document the nature, frequency, and timing of interruptions during specific stages of medication administration in a chemotherapy daycare unit. RESULTS: Nurses were interrupted, on average, 22% of their time and were frequently interrupted while performing safety-critical tasks. Task completion times were greater for interrupted tasks than for uninterrupted tasks. CONCLUSION: Nurses are frequently interrupted during safety-critical stages of medication administration, which decreases task efficiency and could lead to adverse events.

Validation of supervised automated algorithm for fast quantitative evaluation of organ motion on magnetic resonance imaging.

PURPOSE: To validate a correlation coefficient template-matching algorithm applied to the supervised automated quantification of abdominal-pelvic organ motion captured on time-resolved magnetic resonance imaging. METHODS AND MATERIALS: Magnetic resonance images of 21 patients across four anatomic sites were analyzed. Representative anatomic points of interest were chosen as surrogates for organ motion. The point of interest displacements across each image frame relative to baseline were quantified manually and through the use of a template-matching software tool, termed "Motiontrack." Automated and manually acquired displacement measures, as well as the standard deviation of intrafraction motion, were compared for each image frame and for each patient. RESULTS: Discrepancies between the automated and manual displacements of > or =2 mm were uncommon, ranging in frequency of 0-9.7% (liver and prostate, respectively). The standard deviations of intrafraction motion measured with each method correlated highly (r = 0.99). Considerable interpatient variability in organ motion was demonstrated by a wide range of standard deviations in the liver (1.4-7.5 mm), uterus (1.1-8.4 mm), and prostate gland (0.8-2.7 mm). The automated algorithm performed successfully in all patients but 1 and substantially improved efficiency compared with manual quantification techniques (5 min vs. 60-90 min). CONCLUSION: Supervised automated quantification of organ motion captured on magnetic resonance imaging using a correlation coefficient template-matching algorithm was efficient, accurate, and may play an important role in off-line adaptive approaches to intrafraction motion management.