Rh(D) immune globulin administration in pregnancy: Retrospective audit of patient safety events followed by targeted educational intervention with Bayesian analysis.

OBJECTIVES: To examine local patient safety events related to the administration of anti-Rh(D) immune globin (RhIG) during pregnancy, and to follow-up with targeted educational intervention to improve knowledge of this process. BACKGROUND: Administration RhIG is established treatment for the prevention of haemolytic disease of the foetus and newborn (HDFN). However, patient safety events in relation to its correct use continue to occur. METHODS: A retrospective audit of patient safety events related to RhIG administration during pregnancy was performed. Targeted educational intervention in the form of PowerPoint® presentation were given to nursing staff, laboratory staff and physicians and evaluated with pre- and post-tests using multiple-choice questions given immediately before and after the presentation. RESULTS: An annual incidence of 0.24% of patient safety events related to the administration of RhIG during pregnancy was found. These events were mostly in the preanalytical phase, for example mislabelled samples or samples for D-rosette/Kleihauer-Betke testing drawn from the baby, not the mother. Using Bayesian analysis, the probability of positive effect for the targeted educational intervention was 100% with a median improved score of 29%. This was compared with a control group using standard curriculum education intervention based on the current curriculum for nursing, laboratory and medical students which showed a median improved score of only 4.4%. CONCLUSIONS: Administration of RhIG during pregnancy is a multistep process involving health care professionals of several disciplines providing opportunities to enhance the curriculum for nursing, laboratory and medical students and to ensure on-going education.

A Systematic Review and Meta-Analysis of Preoperative Frailty Instruments Derived From Electronic Health Data.

BACKGROUND: Frailty is a strong predictor of adverse outcomes in the perioperative period. Given the increasing availability of electronic medical data, we performed a systematic review and meta-analysis with primary objectives of describing available frailty instruments applied to electronic data and synthesizing their prognostic value. Our secondary objectives were to assess the construct validity of frailty instruments that have been applied to perioperative electronic data and the feasibility of electronic frailty assessment. METHODS: Following protocol registration, a peer-reviewed search strategy was applied to Medline, Excerpta Medica dataBASE (EMBASE), Cochrane databases, and the Comprehensive Index to Nursing and Allied Health literature from inception to December 31, 2019. All stages of the review were completed in duplicate. The primary outcome was mortality; secondary outcomes included nonhome discharge, health care costs, and length of stay. Effect estimates adjusted for baseline illness, sex, age, procedure, and urgency were of primary interest; unadjusted and adjusted estimates were pooled using random-effects models where appropriate or narratively synthesized. Risk of bias was assessed. RESULTS: Ninety studies were included; 83 contributed to the meta-analysis. Frailty was defined using 22 different instruments. In adjusted data, frailty identified from electronic data using any instrument was associated with a 3.57-fold increase in the odds of mortality (95% confidence interval [CI], 2.68-4.75), increased odds of institutional discharge (odds ratio [OR], 2.40; 95% CI, 1.99-2.89), and increased costs (ratio of means, 1.54; 95% CI, 1.46-1.63). Most instruments were not multidimensional, head-to-head comparisons were lacking, and no feasibility data were reported. CONCLUSIONS: Frailty status derived from electronic data provides prognostic value as it is associated with adverse outcomes, even after adjustment for typical risk factors. However, future research is required to evaluate multidimensional instruments and their head-to-head performance and to assess their feasibility and clinical impact.

Concerns and perceived obstacles for females with regards to cardiac surgery residency-A survey.

BACKGROUND: A major difference exists between the rate of females and males entering cardiac surgery (CSx) residency in Canada. The objective of this study was to investigate the concerns and perceived obstacles of medical students with regards to CSx residency training to identify potential modifiable factors. METHODS: A 15-question web-based survey was designed to compare male to female medical students' perceptions with regards to CSx training. The survey was distributed to all 682 medical students at Western University (London, ON, Canada) enrolled during 2018 to 2019 academic year. A total of 153 students (63 males vs 90 females) completed the survey. RESULTS: More females perceived significant levels of difficulties to getting accepted in CSx residency programs (44/63 [63.8%] males vs 77/90 [85.6%] females, P = .03). As for their perception of the most difficult aspect about a career in CSx, more males expressed significant concerns about finding a job after completing the residency training (16/63 [25.3%] males vs 10/90 [11.0%] females, P = .02). A similar proportion of students expressed a strong interest in applying to a CSx residency (12/63 [19.0%] males vs 15/90 [16.7%] females, P = .83). Of these, more males expressed concerns about maintaining a work-life balance (6/12 [50%] males vs 1/15 [6.67%] female, P = .02), and more females expressed fears of not getting matched to CSx residency (3/12 [25%] males vs 11/15 [73.3%] females, P = .02). CONCLUSION: Despite showing a strong interest in completing a residency in CSx, female medical students perceive a significant fear of not getting matched to the speciality, which limits them from applying.