Using Dominance Analysis to Identify the Most Important Dimensions of Safety Culture for Predicting Patient Safety

Mammal dung-dung beetle trophic networks: an improved method based on gut-content DNA

Background

Dung beetles provide many important ecosystem services, including dung decomposition, pathogen control, soil aeration, and secondary seed dispersal. Yet, the biology of most dung beetles remains unknown. Natural diets are poorly studied, partly because previous research has focused on choice or attraction experiments using few, easily accessible dung types from zoo animals, farm animals, or humans. This way, many links within natural food webs have certainly been missed. In this work, we aimed to establish a protocol to analyze the natural diets of dung beetles using DNA gut barcoding.

Methods

First, the feasibility of gut-content DNA extraction and amplification of 12s rDNA from six different mammal dung types was tested in the laboratory. We then applied the method to beetles caught in pitfall traps in Ecuador and Germany by using 12s rDNA primers. For a subset of the dung beetles caught in the Ecuador sampling, we also used 16s rDNA primers to see if these would improve the number of species we could identify. We predicted the likelihood of amplifying DNA using gut fullness, DNA concentration, PCR primer, collection method, and beetle species as predictor variables in a dominance analysis. Based on the gut barcodes, we generated a dung beetle-mammal network for both field sites (Ecuador and Germany) and analyzed the levels of network specificity.

Results

We successfully amplified mammal DNA from dung beetle gut contents for 128 specimens, which included such prominent species as Panthera onca (jaguar) and Puma concolor (puma). The overall success rate of DNA amplification was 53%. The best predictors for amplification success were gut fullness and DNA concentration, suggesting the success rate can be increased by focusing on beetles with a full gut. The mammal dung-dung beetle networks differed from purely random network models and showed a moderate degree of network specialization (H2': Ecuador = 0.49; Germany = 0.41).

Conclusion

We here present a reliable method of extracting and amplifying gut-content DNA from dung beetles. Identifying mammal dung via DNA reference libraries, we created mammal dung-dung beetle trophic networks. This has benefits over previous methods because we inventoried the natural mammal dung resources of dung beetles instead of using artificial mammal baits. Our results revealed higher levels of specialization than expected and more rodent DNA than expected in Germany, suggesting that the presented method provides more detailed insights into mammal dung-dung beetle networks. In addition, the method could have applications for mammal monitoring in many ecosystems.

COVID-19 Mitigation Activities in Inpatient Psychiatry Were Associated With Patient-Reported Institutional Betrayal, Changes in Trust, and Fear of Getting Sick

Institutional betrayal occurs when the institutions that people depend on fail to protect them from harm, which was exemplified by a failure to manage COVID-19 risks. Inpatient psychiatry provides a rich context for which to understand the effects of institutional betrayal, and this is amplified in the context of the COVID-19 pandemic. Using a retrospective cohort design, we administered an online survey to former patients (n = 172) of inpatient psychiatry hospitalized at the height of the COVID-19 pandemic (March 2020 to February 2021) to understand the relationship between facilities' use of COVID-19 mitigation activities (ie, offering or requiring face masks, keeping patients and staff 6 feet apart, access to hand sanitizer, use of telemedicine for clinical consults, and routine cleanliness of the unit) and former patients' reports of institutional betrayal, changes in their trust in mental healthcare providers, fear of getting sick, and having contracted or witnessed someone else contract COVID-19. The quantity of COVID-19 mitigation activities was monotonically negatively associated with the probability of reporting any betrayal, the probability of reduced trust in mental healthcare providers, and the probability of being afraid of getting sick always or most of the time while hospitalized. COVID-19 mitigation activities either directly affected these psychological outcomes, or facilities that engaged in robust mitigation had greater cultures of safety and care quality. Additional qualitative work is needed to understand these mechanisms.

Patient Safety Perception Within Hospitals: An Examination of Job Type, Handoffs and Information Exchange, and Hospital Management Support

OBJECTIVES

The study has 3 aims: (1) to assess to what extent a person's job role relates to their evaluation of patient safety in the hospital setting; 2) to identify the relationship from hospital management aspects, including level of organizational learning-continuous improvement, level of management support, and level of leader support to patient safety perception in the hospital setting; and 3) to examine the relationship between the rating of the ease of information exchange and clinical handoffs and perceived patient safety in the hospital setting.

METHODS

This study used a publicly available, deidentified cross-sectional data set from the 2021 Agency for Healthcare Research and Quality's Survey on Patient Safety Culture Hospital Survey 2.0. Welch's analysis of variance and multiple linear regression were used to examine each factor's impact on patient safety rating.

RESULTS

Supervisors had a higher ( P < 0.001) patient safety perception than people in other job types, whereas nurses had a lower ( P < 0.001) patient safety perception than other job types. Level of organizational learning-continuous improvement ( P < 0.001), level of hospital management ( P < 0.001), level of leader support ( P < 0.001), and ease of handoffs and information exchange ( P < 0.001) were positively related to perceived patient safety.

CONCLUSIONS

This study highlights the importance of identifying the unique issues affecting nurses and supervisors, different from other job types, that may explain their lower patient safety ratings. Findings from this study suggest that it is critical for organizations to focus on initiatives and policies that promote leadership, management, ease in information exchange and handoffs, and continuous learning.

Development of a scale measuring home-visiting nurses' attitudes toward patient safety: a cross-sectional study

BACKGROUND

Home-visiting nurses are required to recognize risks in their work, ensure patient safety according to the characteristics of home-visiting nursing, and therefore, effectively support stability in patients' lives. In this study, we created a scale measuring home-visiting nurses' attitudes toward patient safety and examined its reliability and validity.

METHODS

A total of 2,208 home-visiting nurses from Japan were randomly selected as participants. From the 490 responses collected (response rate: 22.2%), 421 responses with no missing values, other than those related to participants' basic information (valid response rate: 19.0%), were analyzed. Participants were randomly divided into two groups: 210 for exploratory factor analysis (EFA) and 211 for confirmatory factor analysis (CFA). To examine the reliability of the home-visiting nurses attitude scale developed in this study, ceiling and floor effects, inter-item correlations, and item-total correlations were checked. Subsequently, EFA was performed to confirm the factor structure. CFA, composite reliability, average variance extracted, and Cronbach's alpha for each factor were extracted to confirm the factor structure of the scale and the validity of the model.

RESULTS

The home-visiting nurses' attitudes toward patient safety were measured using 19 questionnaire items related to four factors: "Self-improvement for patient safety," "Incident awareness," "Counter measures based on incident experience," and "Nursing care to protect the lives of patients." Cronbach's α coefficients were 0.867, 0.836, 0.773, and 0.792 for Factors 1-4, respectively. Model indicators were χ² = 305.155, df = 146, p < 0.001, TLI = 0.886, CFI = 0.902, RMSEA = 0.072 (90% confidence interval 0.061-0.083).

CONCLUSIONS

From the results of the CFA, criterion-related validity, and Cronbach's α coefficient, this scale is considered reliable and valid and thus, highly appropriate. Therefore, it may be effective at measuring home-visiting nurses' attitudes toward patients' medical safety from both behavioral and awareness aspects.

Factors Affecting Patient Safety Culture from Nurses’ Perspectives for Sustainable Nursing Practice

Individual and group beliefs, attitudes, perceptions, competences, and behavioral patterns all contribute to the safety culture of a healthcare company. The study’s goal is to assess nurses’ perceptions of elements that influence patient safety culture in order to promote long-term nursing practice. A descriptive cross-sectional study design was done among a sample of 146 nurses who were recruited from one hospital in Egypt. They completed a self-administered, printed questionnaire. The questionnaire assessed participants’ socio-demographic data and their perception regarding patient safety culture for sustainable nursing practices. The findings revealed that nursing staff had a high perception regarding patient safety culture a with mean score (159.94 ± 7.864). Also, the highest percentage (74.66%) of had no safety events reported yearly. Creating a unit-specific patient safety culture suited to the competences of the unit’s RNs in patient safety practice would be crucial to increasing and sustaining high levels of patient safety attitudes, skills, and knowledge among the unit’s RNs, influencing patient safety. When implementing interventions to promote patient safety and reporting culture in hospitals, policymakers, hospital administrators, and nurse executives should take the current findings into account. A multidimensional network intervention addressing many elements of patient safety culture and integrating different organizational levels should be implemented to enhance patient safety and a no-blame culture.

The Significance of Estimated Glomerular Filtration Rate for Predicting Mortality in Glyphosate Herbicide-Intoxicated Patients: A Single-Center, Retrospective Observational Study

Background: Glyphosate herbicide (GH) is widely used worldwide. It has a higher fatality rate than expected. GH-poisoned cases are increasingly reported. Acute kidney injury in poisoned patients is one of several predictors of GH mortality. The aim of this study was to determine whether estimated glomerular filtration rate (eGFR) could predict kidney injury in GH intoxication. Methods: This was a retrospective study conducted at the emergency department (ED) of a single hospital between January 2004 and December 2021. A total of 434 patients presented with GH intoxication via oral ingestion, and 424 were enrolled. Their demographic characteristics, laboratory variables, complications, and mortality were analyzed to determine clinical predictors associated with GH-induced mortality using a logistic regression analysis. The relationship between GH intoxication and eGFR was determined based on the results of dominance analysis. Additionally, the comparison of creatinine and eGFR was performed through receiver operating characteristic (ROC) curves. Results: A total of 424 GH-poisoned patients were enrolled. Of them, 43 (10.1%) died. In the multivariable analysis, initial GCS (OR: 0.874; 95% CI: 0.765−0.998, p = 0.047), albumin (OR: 0.874; 95% CI: 0.765−0.998, p = 0.027), pH (OR: 0.002; 95% CI: 0.000−0.037, p < 0.001), QTc interval (OR: 1.018; 95% CI: 1.007−1.029, p = 0.001), and eGFR (OR: 0.969; 95% CI: 0.95−0.989, p = 0.003) were independent factors for predicting in-hospital mortality. In the dominance analysis of the relative importance of the predictive factors, pH accounted for the largest proportion at 35.8%, followed by QTc (20.0%), GCS (17.3%), eGFR (17.0%), and albumin (9.9%). Additionally, eGFR had a larger area under the ROC curve (0.846; 95% CI, 0.809−0.879) than that of creatinine (0.811; 95% CI, 0.771−0.848, p = 0.033). Conclusion: In sum, eGFR, considered a surrogate of renal function, was a useful prognostic factor for mortality in glyphosate herbicide-poisoned patients.

Patient Safety Culture and Its Associated Factors: A Situational Analysis among Nurses in Katsina Public Hospitals, Northwest Nigeria

Background: Patient safety involves identifying, assessing, and managing patient-related risks and occurrences to improve patient care and reduce patient harm. In Nigeria, there is a lack of studies on patient safety culture, especially in the northern part of the country. This study aimed to determine the levels and factors that contribute to nurses’ negative perceptions of patient safety culture in public health facilities. Methodology: A total of 460 nurses were surveyed across 21 secondary health facilities using the Hospital Survey on Patient Safety Culture, and the response rate was 93.5%. Descriptive statistics and multiple logistic regression were used to analyze the data. Results: The results showed that 59.8% of the respondents were female, and 42.6% were within the age range of 30–39 years old. Most of them (48.3%) had spent 1–5 years working in the hospital. Three out of 12 composite measures had higher negative responses (staffing—30.5%, non-punitive response to error—42.8%, and frequency of events reported—43.1%). A multiple logistic regression analysis affirmed that all three variables, in addition to organizational learning, were significant associated with overall negative perceptions of patient safety culture, with 3.15, 1.84, 2.26, and 2.39 odds ratios, respectively. Conclusion: The results revealed that four critical areas of patient safety required improvement; therefore, intervention is recommended to minimize unnecessary patient harm and medical expenses.