Proposed model to determine satisfaction with computerised provider order entry systems in a long-stay hospital.

OBJECTIVES: Computerised provider order entry (CPOE) systems reduce medication errors, but are not without dangers. Knowing satisfaction with the CPOE helps to improve its implementation. Our objective was to determine the satisfaction of healthcare professionals with the CPOE in a long-stay hospital and to propose a single model. METHODS: A cross-sectional study in a long-stay hospital. Two questionnaires were distributed to determine satisfaction with CPOE, one for medical personnel (MP) and another for nursing personnel (NP). Data collected were: sex, age and work aspects. A strategy for item refinement and creation of a single scale was designed. RESULTS: The overall participation rate was 63.6%, with 68 responses from the target population of 107. Overall, 72.2% (13 of 18) of MP and 40% (20 of 50) of NP were satisfied with CPOE. Regarding the specific questions on satisfaction in the questionnaires, 88.9% (n=16) of MP were very satisfied but only 56.0% (n=28) of NP. The median of each question was 4, with the exception of those for NP referring to a faster process and improved coordination, which were 3 and 3.5, respectively. The items weighing more in the second component were eliminated and the questions merged. After refining the items, a final six-item model was obtained with a single component of high reliability (Cronbach's α=0.896), which accounts for 67% of total variance. CONCLUSION: The degree of satisfaction with CPOE in a long-stay hospital was high, though lower in NP than MP. Obtaining a single questionnaire can facilitate this process.

Evaluation of formaldehyde as an ocular irritant: a systematic review and Meta-analysis.

OBJECTIVE: The aim of this study was to use meta-regression to evaluate the safety of the maximum allowable dose of formaldehyde in terms of eye irritation symptoms. METHODS: We performed a systematic review of literature published in the PubMed, Embase, Lilacs, Web of Science, and Cochrane Library databases. We selected clinical trials, cohort studies, and case-control studies that compared eye irritation between patients exposed and not exposed to formaldehyde. Eighteen of the 2561 studies retrieved met the inclusion criteria. Data were extracted using structured forms and study quality was analyzed using the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) checklist. Odds ratios (ORs) were calculated using a random effects model with stratification by airborne dose and subsequent meta-regression analysis. RESULTS: The random effects model yielded an OR of 8.11 (95% CI: 5.85-10.37), with an I2 statistic of 99.8% and p < 0.00001. In the meta-regression analysis, we observed an I2 of 87.29% with an R2 of 23.96; the regression line for exposure had a slope of 1.466 (95% CI: 0.096-2.836) in relation to the Napierian log of the OR. Considering a safety level based on an OR of 2 relative to the unexposed group, an airborne concentration of formaldehyde of less than 0.001 mg/m3 can be considered safe. CONCLUSION: Although current formaldehyde exposure concentrations are relatively safe in terms of cancer risk, they continue to cause eye irritation.

Effectiveness of Intracameral Phenylephrine in Achieving Mydriasis and Reducing Complications During Phacoemulsification: A Systematic Review and Meta-Analysis.

PURPOSE: To compare the effectiveness of intracameral phenylephrine and topical mydriatics in achieving mydriasis and protecting against complications during phacoemulsification. METHODS: A systematic search of the literature comparing the mydriatic effect and surgical safety profile of intracameral phenylephrine and topical mydriatics in phacoemulsification was conducted in the Medline, Embase, Lilacs, Web of Science, Cochrane, ClinicalTrials.gov , and Teseo databases. The search targeted clinical trials, cohort studies, and case-control studies published between April 20, 2003 and August 14, 2016. Mydriatic effect was assessed by difference in means in pupil of all the patients in the studies [mean difference (MD)] and intraoperative complications were assessed by using inverse-variance weighted odds ratios (ORs), with adjustment for dose. A meta-regression analysis was also conducted, with adjustment for dose, use of epinephrine, tamsulosin use, and type of surgery and type of intraocular lens. RESULTS: We found 7 articles about mydriatic effect and another 7 about complications. Intracameral phenylephrine achieved a similar mydriatic effect to topical mydriatics, with a difference of less than 10% (MD -0.74 mm, 95% CI: -1.67 to 0.18, I2 = 95.8%, P < 0.0001). The pooled OR for complications was OR 0.50, 95% CI: 0.19-1.31, I2 = 0.0%, P = 0.670, and posterior capsular rupture was the most common complication in the different studies analyzed. CONCLUSION: Intracameral phenylephrine achieves a similar mydriatic effect to topical mydriatics (difference <15%) and is associated with a not-significant effect on reducing the odds of intraoperative complications.

Intraocular lens dislocation in pseudoexfoliation: a systematic review and meta-analysis.

PURPOSE: To evaluate the impact of pseudoexfoliation syndrome on intraocular lens (IOL) dislocation after phacoemulsification cataract surgery and explore possible associations related to surgical technique. METHODS: We systematically searched the MEDLINE, Embase, Web of Science, Cochrane, and Lilacs databases and grey literature sources and identified (on March 1, 2016) 14 cohort and case-control studies comparing IOL dislocation in patients with and without pseudoexfoliation syndrome who had undergone phacoemulsification. Study quality was assessed using the STROBE scale. An inverse-variance fixed-effects model was used to calculate weighted odds ratios (ORs) and 95% confidence intervals (CI). RESULTS: The pooled analysis yielded an OR of 6.02 (95% CI: 3.7, 9.79) for IOL dislocation in patients with pseudoexfoliation, and similarly, high ORs were detected for both early and late (3 months after surgery) dislocation (OR 5.26; 95% CI: 1.05; 26.32 versus OR 6.02; 95% CI: 3.67; 10.17). No significant associations were detected when the results were stratified by year, incision size or use of hooks or retractors. CONCLUSIONS: Patients with pseudoexfoliation syndrome have a high risk of late IOL dislocation after phacoemulsification cataract surgery, and this risk may be related to the use of large incisions and hooks or retractors.