Improving quality and patient safety in surgical care through standardisation and harmonisation of perioperative care (SAFEST project): A research protocol for a mixed methods study.

INTRODUCTION: Adverse events in health care affect 8% to 12% of patients admitted to hospitals in the European Union (EU), with surgical adverse events being the most common types reported. AIM: SAFEST project aims to enhance perioperative care quality and patient safety by establishing and implementing widely supported evidence-based perioperative patient safety practices to reduce surgical adverse events. METHODS: We will conduct a mixed-methods hybrid type III implementation study supporting the development and adoption of evidence-based practices through a Quality Improvement Learning Collaborative (QILC) in co-creation with stakeholders. The project will be conducted in 10 hospitals and related healthcare facilities of 5 European countries. We will assess the level of adherence to the standardised practices, as well as surgical complications incidence, patient-reported outcomes, contextual factors influencing the implementation of the patient safety practices, and sustainability. The project will consist of six components: 1) Development of patient safety standardised practices in perioperative care; 2) Guided self-evaluation of the standardised practices; 3) Identification of priorities and actions plans; 4) Implementation of a QILC strategy; 5) Evaluation of the strategy effectiveness; 6) Patient empowerment for patient safety. Sustainability of the project will be ensured by systematic assessment of sustainability factors and business plans. Towards the end of the project, a call for participation will be launched to allow other hospitals to conduct the self-evaluation of the standardized practices. DISCUSSION: The SAFEST project will promote patient safety standardized practices in the continuum of care for adult patients undergoing surgery. This project will result in a broad implementation of evidence-based practices for perioperative care, spanning from the care provided before hospital admission to post-operative recovery at home or outpatient facilities. Different implementation challenges will be faced in the application of the evidence-based practices, which will be mitigated by developing context-specific implementation strategies. Results will be disseminated in peer-reviewed publications and will be available in an online platform.

Comparative Analysis of the Impact of Training through Simulation Using the Crisis Resource Management Tool for Primary Care Professionals.

This was a prospective observational study based on clinical simulation courses taught in 2017 at the IDEhA Simulation Center of Alcorcón Foundation University Hospital. Two courses in metabolic emergencies (MEs) and respiratory emergencies (REs) were offered to primary care physicians all over Spain. The main objective was to teach nontechnical skills (crisis resource management). Using a modified five-level Kirkpatrick-Phillips education evaluation model, level I (reaction, K1), level II (learning, K2) and level III (behavioral change, K3) changes were evaluated through surveys at the end of the courses and one year later. Thirty courses were held (15 ME courses and 15 RE courses) with 283 primary care physicians. The overall satisfaction (K1) was high: ME courses, 9.5/10; RE courses, 9.6/10. More than 80% of the participants rated the organization, resources, content, debriefing and scenarios as excellent, with no significant differences between the two courses. After one year (156 responses), the respondents for both courses reported that they would repeat the training annually (K2), encourage debriefing with colleagues (K3) and have modified some aspects of their workplace (K3), citing improvements in procedures and in the organization of the health team as the most important. After the ME course, few participants, i.e., 5 (6%), reported providing improved care to patients; after the RE course, 15 (19%) participants reported providing improved care; the difference between groups was significant (p < 0.05). Compared with the ME course, the RE course imparted greater knowledge about patient safety (K2) (38 (49%) vs. 24 (31%) (p < 0.05)) and more useful tools for daily clinical practice (K3) (67% vs. 56.4%) and resulted in participants paying more attention to personal performance and to colleagues when working as a team (K2) (64% vs. 50%). Clinical simulation courses are highly valued and potentially effective for training primary care physicians in patient safety and CRM tools. Future studies with objective measures of long-term impact, behavior in the workplace (K3) and benefits to patients (K4) are needed. Based on the results of our study, the areas that are important are those aimed at improving procedures and the organization of health teams.

Prediction of some physicochemical properties in Colombian crude oils upgraded by catalytic aquathermolysis using UV-VIS spectroscopy associated with chemometric methods.

The simulated distillation curve (ASTM/D-7169) is a quantitative method to determine fractions of crude oils by boiling point temperature ranges (36-720 °C). In this work, 45 samples of typical Colombian crudes were selected, and the samples were produced under conventional process. Also 8 upgraded crude oils under catalytic aquathermolysis conditions at laboratory scale were added. The tests were developed at 270 °C and 800psi (@25 °C) during 66 h of reaction. In addition, 30 samples were selected for density tests, according to the pycnometer method. Subsequently, the crude oil samples under study were diluted in chloroform and analyzed by UV-VIS Spectroscopy. The UV-VIS spectra were correlated with selected properties by using PCA-MLR and PLS models. The distillation curves of the crude oils were modelled using the Riazi probability function. The prediction models of parameters To, A, and B from the Riazi probability function exhibited R2 correlation coefficients, higher than 0.94. The correlation model for the crude oil density showed a much better coefficient, higher than 0.99 and Root-Mean-Squared-Error (RMSE) close to 0.004. Additionally, even more important is the contribution of the use of UV-VIS spectroscopy as a useful tool to quickly evaluate the quality of crude oil.

The three ages balance for patient safety.

The evolution of the patient safety perspectives, the technological age, the human factor age and the safety management age, have no clear cut and coexist. The current edition of the Current Opinion in Anesthesiology Technology, Education and Safety section presents an eclectic compendium of articles addressing these views from the technological improvements, human factor developments and organizational safety management impacting patient safety. Every solution, every patch to fill the cheese hole, holding the domino piece to fall, opens a new disruption elsewhere that needs to be addressed following the zero-preventable harm path.

Which people with diabetes are treated with a disposable, half-unit insulin pen? A real-world, retrospective, database study in Spain.

INTRODUCTION: Insulin lispro 100 units/mL Jr KwikPen is the first prefilled, disposable, half-unit insulin pen that delivers 0.5-30 units in increments of 0.5 units for the treatment of patients with diabetes. This study describes the profile of patients in Spain who initiated insulin therapy with Jr KwikPen in a real-world setting. METHODS: This retrospective, observational study based on IQVIA's electronic medical records database included patients with Type 1 (T1D) or Type 2 (T2D) diabetes who initiated therapy with Jr KwikPen between May 2018 and December 2020. Sociodemographic, clinical, and treatment characteristics at treatment initiation were analysed descriptively. RESULTS: A total of 416 patients were included. The main characteristics of the T1D/T2D groups (N = 326/90), respectively were as follows: female sex, 61.7%/65.6%; mean age (standard deviation [SD]), 32.5 (20.7)/55.5 (16.6) years; body mass index, 20.9 (4.2)/25.2 (4.6) kg/m2 (N = 239/77); HbA1c, 7.8 (1.7)%/8.0 (1.5)% (N = 141/64); and presence of diabetes-associated comorbidities, 27.9%/64.4%. Only 32.8% of patients with T1D were < 18 years old. Among Jr KwikPen users, 12.3% (T1D/T2D, 7.7%/28.9%) were ≥ 65 years old, 17.1% patients were newly diagnosed, and 3.8% were pregnant women. The mean (SD) total insulin dose pre-index for T1D/T2D was 43.1 (23.6) and 40.7 (21.6) UI/day, respectively. The mean (SD) insulin dose at the start of Jr KwikPen use was 26.63 (16.56) and 22.58 (13.59) UI/day for T1D/T2D, respectively. Jr KwikPen was first prescribed mainly by endocrinologists (58.7%) or paediatricians (22.6%). CONCLUSIONS: The profile of patients who initiated therapy with Jr KwikPen in routine practice was broad with many patients being adults. Most of these patients had T1D, inadequate glycemic control, and multiple associated comorbidities. These results suggest that Jr KwikPen is prescribed in patients who may benefit from finer insulin dose adjustments, namely children, adolescents, adults, older individuals, or pregnant women with T1D or T2D.

Can we nudge to reduce the perioperative low value care? Decision making factors influencing safe practice implementation.

PURPOSE OF THE REVIEW: Highlight sources of low-value care (LVC) during the perioperative period help understanding the decision making behind its persistence, the barriers for change, and the potential implementation strategies to reduce it. RECENT FINDINGS: The behavioural economics science spread of use through aligned strategies or nudge units offer an opportunity to improve success in the LVC reduction. SUMMARY: LVC, such as unneeded surgeries, or preanaesthesia tests for low-risk surgeries in low-risk patients, is a relevant source of waste and preventable harm, most especially in the perioperative period. Despite the international focus on it, initial efforts to reduce it in the last decade have not clearly shown a sustainable improvement. Understanding the shared decision-making process and the barriers to be expected when tackling LVC is the first step to build the change. Applying a structured strategy based on the behavioural science principles may be the path to increasing high value care in an effective an efficient way. It is time to foster nudge units at different healthcare system levels.

A new species of Ambrysus Stål from west-central Mexico and new records for Ambrysus dyticus La Rivers in Central America (Heteroptera: Nepomorpha: Naucoridae).

The new species Ambrysus inecol Reynoso n. sp. from Mexico, which belongs to Section 3 of the Ambrysus signoreti Stål complex, is herein described and illustrated. This brings the total number of described species in the genus to 69, of which 61 belong to the nominal subgenus and 25 to the A. signoreti complex. Also, new country and department/state records are reported for the Central American A. dyticus La Rivers.

Revision of the Ambrysus signoreti Stål species complex (Heteroptera: Naucoridae: Ambrysinae). Section 2.

The Ambrysus signoreti Stål species complex was recently diagnosed and subdivided into three sections based on morphology of the female subgenital plate. In the present study, the species in the second section, characterized by the posterior margin of the subgenital plate with central lobe extending posteriorly further than the posterolateral corners, are revised. Supplemental descriptions for four species described by La Rivers and Usinger are provided. The group includes six species: four from Mexico (Ambrysus brailovskyi Reynoso & Sites, A. henryi Reynoso & Sites, A. inflatus La Rivers, A. lundbladi Usinger), one from Mexico and the United States (A. lunatus Usinger), and one from Costa Rica (A. harmodius La Rivers). Also, the subspecies A. lunatus menoides La Rivers is proposed as a junior synonym of A. lundbladi. We herein report for the first time characteristics of the previously unknown male of A. lundbladi. Additionally, we present new state records from Mexico for A. inflatus and A. lundbladi, and new province records from Costa Rica for A. harmodius. Finally, an illustrated key to the species in the second section of the complex is provided.

Solution NMR structure of cementum protein 1 derived peptide (CEMP1-p1) and its role in the mineralization process.

We report the characterization of the three-dimensional structure of the CEMP1-p1 peptide [MGTSSTDSQQAQHRRCSTSN: corresponding to residues 1-20 of the N-terminus of cementum protein 1 (CEMP1)]. This peptide imitates the capacity of CEMP1 to stimulate hydroxyapatite (HA) crystal nucleation and growth, and promotes the differentiation of periodontal ligament cells into a cementoblastic phenotype. Additionally, in experimental models of critical-sized calvarial defects in Wistar rats, CEMP1-p1 has shown osteogenic properties that enhanced the physiological deposition and maturation of newly formed bone. In this work, studies of CEMP1-p1 by circular dichroism (CD) and nuclear magnetic resonance (NMR) were performed in trifluoroethanol D2 (TFED2) and aqueous solution to determine the 3D structure of the peptide. Using the 3D model, experimental data from HA crystals formation and calcium fluorescence emission, we explain the biological mechanisms involved in CEMP1-p1 activity to promote calcium recruitment and its affinity to HA crystals. This information is valuable because it proposes, for the first time, a plausible molecular mechanism during the mineralization process, from a specific cementum protein-derived peptide.

Learning from errors and resilience.

PURPOSE OF REVIEW: Learning from errors has been the main objective of patient safety initiatives for the last decades. The different tools have played a role in the evolution of the safety culture to a nonpunitive system-centered one. The model has shown its limits, and resilience and learning from success have been advocated as the key strategies to deal with healthcare complexity. We intend to review the recent experiences in applying these to learn about patient safety. RECENT FINDINGS: Since the publication of the theoretical basis for resilient healthcare and Safety-II, there is a growing experience applying these concepts into reporting systems, safety huddles, and simulation training, as well as applying tools to detect discrepancies between the intended work as imagined when designing the procedures and the work as done when front-line healthcare providers face the real-life conditions. SUMMARY: As part of the evolution in patient safety science, learning from errors has its function to open the mindset for the next step: implementing learning strategies beyond the error. The tools for it are ready to be adopted.

Extension of patient safety initiatives to perioperative care.

PURPOSE OF REVIEW: Patient safety has significantly improved during the intraoperative period thanks to the anesthesiologists, surgeons, and nurses. Nowadays, it is within the perioperative period where most of the preventable harm happened to the surgical patient. We aim to highlight the main issues and efforts to improve perioperative patient safety focusing and the relation to intraoperative safety strategies. RECENT FINDINGS: There is ongoing research on perioperative safety strategies aiming to initiate multidisciplinary interventions on early stages of the perioperative period as well as an increasing focus on preventing harm from postoperative complications. SUMMARY: Any patient safety strategy to be implemented needs to be framed beyond the operating room and include in the intervention the whole perioperative period.

Revision of the Ambrysus signoreti Stål species complex (Heteroptera: Naucoridae: Ambrysinae). Section 1.

The species-rich Ambrysus signoreti Stål species complex is diagnosed and subdivided into three sections based on morphology of the female subgenital plate. The species in the first section, characterized by the posterior margin of the subgenital plate with posterolateral corners extending posteriorly further than the central lobe, are revised. The group includes four species: two previously described from Mexico (Ambrysus cosmius La Rivers, A. schuhi Reynoso & Sites), one from Costa Rica (A. variegatus Usinger), and a new species, A. morelosensis n. sp., from central Mexico. The description of the new species and transfer of A. mormon Montandon to the A. guttatipennis Stål species complex brings the total number of species in the complex to 24 and the total number of described species of Ambrysus to 68. Also, an illustrated key to the species in this first section of the complex is provided. Finally, we present new state records from Mexico for A. cosmius and new province records from Costa Rica for A. variegatus.

Mononuclear and Tetranuclear Copper(II) Complexes Bearing Amino Acid Schiff Base Ligands: Structural Characterization and Catalytic Applications.

Two new glycine-Schiff base copper(II) complexes were synthesized. Single crystal X-ray diffraction (SCXRD) allowed us to establish the structure of both complexes in the solid state. The glycine-Schiff base copper(II) complex derived from 2'-hydroxy-5'-nitroacetophenone showed a mononuclear hydrated structure, in which the Schiff base acted as a tridentate ligand, and the glycine-Schiff base copper(II) complex derived from 2'-hydroxy-5'-methylacetophenone showed a less common tetranuclear anhydrous metallocyclic structure, in which the Schiff base acted as a tetradentate ligand. In both compounds, copper(II) had a tetracoordinated square planar geometry. The results of vibrational, electronic, and paramagnetic spectroscopies, as well as thermal analysis, were consistent with the crystal structures. Both complexes were evaluated as catalysts in the olefin cyclopropanation by carbene transference, and both led to very high diastereoselectivity (greater than 98%).

A new species of Ambrysus Stl from the Central Mexican Plateau and new state records for species of the genus in the country (Heteroptera: Nepomorpha: Naucoridae).

The genus Ambrysus Stl is a species-rich genus in which multiple species groups have been proposed, including the North American Ambrysus signoreti Stl complex. The new Mexican species Ambrysus altiplanus Reynoso n. sp., which belongs to the A. signoreti complex, is described and illustrated, bringing the total number of described species of Ambrysus to 67. Also, new state records are reported for three species of the same complex, two of which are endemic to Mexico.

Efecto antioxidante de la miel de abeja sobre la carne de conejo almacenada en refrigeración / Antioxidant effect of bee honey on rabbit meat stored under refrigeration

Resumen La oxidación de lípidos deteriora los alimentos, por lo que se usan antioxidantes sintéticos para disminuirla, sin embargo, estos compuestos en exceso poseen efectos carcinogénicos. Algunas plantas como el orégano, así como la miel de abeja, contienen antioxidantes naturales que no dañan la salud. Hasta el momento no se han encontrado registros del uso de la miel de abeja para disminuir la oxidación lipídica en carne de conejos. El objetivo de este estudio fue evaluar el efecto de la miel de abeja como antioxidante en la carne cruda de lomo de conejo almacenada en refrigeración a 4 °C. Se evaluó la actividad antioxidante (AA) de tres tipos de miel: oscura, ámbar y clara, para mezclarla con la carne de conejo. Se seleccionó la miel oscura por su mayor efecto antioxidante. Se prepararon 64 muestras de 100 g de carne cruda, 32 se mezclaron con 2 g de miel oscura y las otras 32 se dejaron sin miel (control). Las muestras se almacenaron a 4°C y se evaluó la AA y la concentración de malondialdehído (MDA) a los 0 d, 3 d, 6 d y 9 d de almacenamiento. La AA disminuyó y la concentración de MDA aumentó (P < 0.05) con el tiempo de refrigeración (cambios que indican deterioro de la carne). A los 3 d y 6 d, las muestras de carne cruda con miel exhibieron mayor AA (P < 0.05), y a los 6 d, menores valores de MDA (P < 0.05) comparadas con las muestras control (indicando que no hubo deterioro de la carne). La miel oscura de abeja contiene altas concentraciones de antioxidantes naturales que protegen a la carne cruda molida de lomo de conejo contra el daño oxidativo que puede presentarse durante la refrigeración, por lo que se recomienda su uso para este fin.

Abstract Lipid oxidation deteriorates foods; therefore, synthetic antioxidants are used to decrease it. However, excess synthetic antioxidants have carcinogenic effects. Some plants such as oregano, as well as bee honey, contain natural antioxidants which are not harmful to health. No reports were found on the use of bee honey to decrease lipid oxidation in rabbit meat. The objective of this study was to assess the effect of bee honey as antioxidant on raw rabbit loin, refrigerated at 4 °C. The antioxidant activity (AA)of three types of honey was evaluated: dark, amber and clear, to be mixed with rabbit meat. Dark honey was selected for its higher antioxidant effect. 64 samples of 100 g of raw meat were prepared, 32 samples were mixed with 2 g dark honey and the other 32 were left without honey (control). The samples were stored at 4 °C and AA as well as malondialdehyde (MDA) concentrations were evaluated at 0 d, 3 d, 6 d and 9 d of storage. The AA decreased, and the MDA concentration increased (P < 0.05) with refrigeration time (changes that indicate meat spoilage). After 3 d and 6 d, the raw meat samples with honey showed higher AA (P < 0.05) and after 6 d, they showed lower MDA values (P < 0.05) compared to the control samples (these changes indicate no spoilage of meat). Dark bee honey contains high concentrations of natural antioxidants that protect ground raw rabbit loin against oxidative damage that can occur during refrigeration, therefore, its use is recommended for this purpose.

Two new species of Macrodactylus (Coleoptera: Scarabaeidae: Melolonthinae: Macrodactylini) from Mexico and Guatemala.

Two new species of Macrodactylus Dejean (Coleoptera: Scarabaeidae: Melolonthinae: Macrodactylini) from Mexico and Guatemala are described and illustrated: Macrodactylus miguelangeli new species from Mexico and Guatemala, and M. oaxacaensis new species from Mexico. With the descriptions of these two new species, the total number of species of the genus reaches 124. The characteristics of two closely related species are briefly discussed.

Update on early warning scores.

Early warning scores (EWS) have the objective to provide a preventive approach for detecting those patients in general wards at risk of deterioration before it begins. Well implemented and combined with a tiered response, the EWS expect to be a relevant tool for patient safety. Most of the evidence for their use has been published for the general EWS. Their strengths, such as objectivity and systematic response, health provider training, universal applicability and automatization potential need to be highlighted to counterbalance the weakness and limitations that have also been described. The near future will probably increase availability of EWS, reliability and predictive value through the spread and acceptability of continuous monitoring in general ward, its integration in decision support algorithms with automatic alerts and the elaboration of temporal vital signs patterns that will finally allow to perform a personal modelling depending on individual patient characteristics.

Anaesthesia and perioperative incident reporting systems: Opportunities and challenges.

Incident Reporting Systems (IRS) continue to be an important influence on improving patient safety. IRS can provide valuable insights into how to prevent patients from being harmed at the organizational level. But inadequate expectations and misuse, for performance assessment, patient safety measurement or research, have hindered the full IRS potential. Health care organizations need to develop effective strategies built on trust and truth telling to improve the impact of IRS. This requires strategies to address the limited resources to analyse the near-misses or adverse events; avoid the punitive drift through maintaining the anonymity and protective legislation; integrating IRS and avoiding its confusion with mandatory adverse event response systems; training data analysts to focus on the system instead of the individual through a balanced simple taxonomy; combine the analyses at the local level, to reinforce effective and personalized feedback, with the potential of a national or supranational learning platform.

Synthesis, characterization and biological evaluation of octyltrimethylammonium tetrathiotungstate.

Octyltrimethylammonium tetrathiotungstate salt (ATT-C8) was synthesized and its ability to chelate copper was evaluated. The biological and toxic aspects were evaluated by in vitro and in vivo assays, using bovine aorta endothelial cells (BAEC) and zebrafish (Danio rerio) embryos. The obtained results suggest that ATT-C8 has better biocompatibility, showing a significantly lower lethal concentration 50 (LC50) value in comparison to ammonium tetrathiotungstate (ATT). Zebrafish embryos assay results indicate that both tetrathiotungstate salts at the studied concentrations increase the hatching time. Even more, an in vivo assay showed that synthesized materials behave as copper antagonists and have the ability to inhibit its toxicological effects. Also, both materials were found to be active for the in vitro 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay. The characterization of the materials was carried out using the following spectroscopic techniques: Ultraviolet-Visible (UV-Vis), Fourier Transform Infrared (FTIR) and proton nuclear magnetic resonance (1H-NRM).

A new species of Limnocoris Stål (Heteroptera: Naucoridae: Limnocorinae) and new state records for species of the genus in Mexico.

The New World genus Limnocoris Stål includes 73 described species, of which 13 are distributed in North America. A new species, Limnocoris rodriguesi Reynoso n. sp., from Mexico is described and illustrated, bringing the total number of species distributed in the country to eight. An updated checklist of the Mexican fauna of Limnocoris is presented and includes new state records for six species: Limnocoris hintoni La Rivers, L. inornatus Montandon, L. insularis Champion, L. lutzi La Rivers, L. pygmaeus La Rivers, and L. signoreti Montandon. Additionally, distribution maps for each of the species of Limnocoris in Mexico are presented.