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  • 1
    Online Resource
    Online Resource
    Factors that influence the expected length of operation: results of a prospective study
    BMJ ; 2012
    In:  BMJ Quality & Safety Vol. 21, No. 1 ( 2012-01), p. 3-12
    Details
    In: BMJ Quality & Safety, BMJ, Vol. 21, No. 1 ( 2012-01), p. 3-12
    Type of Medium: Online Resource
    ISSN: 2044-5415 , 2044-5423
    URL: Article
    DOI: 10.1136/bmjqs-2011-000169
    Language: English
    Publisher: BMJ
    Publication Date: 2012
    detail.hit.zdb_id: 2592912-4
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  • 2
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    Development and initial psychometric testing of the Intrahospital Transport Safety Scale in intensive care
    BMJ ; 2020
    In:  BMJ Open Vol. 10, No. 10 ( 2020-10), p. e038424-
    Details
    In: BMJ Open, BMJ, Vol. 10, No. 10 ( 2020-10), p. e038424-
    Abstract: To develop and evaluate the psychometric properties of a scale measuring patient safety during the intrahospital transport process for intensive care. Design The scale was developed based on a theoretical model of the work system and patient safety, and items generated from participant observations. A Delphi study with international experts was used to establish content validity. Next, a cross-sectional study was undertaken to inform item reduction and evaluate construct validity and internal consistency. Setting The questionnaire was distributed to healthcare practitioners at 12 intensive care units in Sweden. Participants A total of 315 questionnaires were completed. Eligible participants were healthcare practitioners in the included units that performed an intrahospital transport during the study period. Inclusion criteria were (1) transports of patients within the hospital to undergo an examination or intervention, and (2) transports performed by staff from the intensive care unit. We excluded transports to a step-down unit or hospital ward. Outcome measures Psychometric evaluation, including item analysis, validity and reliability testing. Results Items were reduced from 55 to 24, informed by distributional statistics, initial reliabilities, factor loadings and communalities. The final factor model consisted of five factors, accounting for 59% of variance. All items loaded significantly on only one factor ( 〉 0.35). The original conceptual model of teamwork, transport-related tasks, tools and technologies, environment, and organisation was maintained with regrouping of items. Cronbach’s alpha ranged from 0.72 to 0.82 for each subscale (ie, factor). Conclusions The present study provides a self-report questionnaire to assess patient safety during intrahospital transport of patients in intensive care. The results indicate acceptable validity and reliability of the scale among a sample of Swedish healthcare practitioners. If further confirmatory testing supports the present results, this scale could be a useful tool to better understand safety prerequisites and improve clinical practice.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2020-038424
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2599832-8
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  • 3
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    Online Resource
    Starting at the top: culture change has the potential to advance the patient participation agenda in Iranian hospitals
    BMJ ; 2023
    In:  Evidence Based Nursing
    Details
    In: Evidence Based Nursing, BMJ
    Type of Medium: Online Resource
    ISSN: 1367-6539 , 1468-9618
    URL: Article
    DOI: 10.1136/ebnurs-2023-103698
    Language: English
    Publisher: BMJ
    Publication Date: 2023
    detail.hit.zdb_id: 2045077-1
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  • 4
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    Evaluating the feasibility of a web-based discharge education programme to improve general surgical patients’ postdischarge recovery: a pilot randomised controlled trial
    BMJ ; 2022
    In:  BMJ Open Vol. 12, No. 2 ( 2022-02), p. e054038-
    Details
    In: BMJ Open, BMJ, Vol. 12, No. 2 ( 2022-02), p. e054038-
    Abstract: To assess the feasibility of implementing a web-based discharge education programme for general surgery patients both prior to and after hospital discharge. Design, setting and participants This is a prospective, two-arm, pilot randomised controlled trial. Patients who had a general surgery procedure were recruited from a tertiary hospital between October 2020 and January 2021. Patients were randomly assigned to either the standard education or the web-based education intervention. Intervention The web-based education comprised of three components designed to enhance patients’ knowledge, skills and confidence to improve their engagement with self-care, and the ability to detect any postoperative issues that can arise during the postdischarge period. Main outcomes and measures The primary outcome was feasibility in terms of recruitment, randomisation, retention and treatment fidelity related to intervention delivery, adherence and satisfaction. Secondary outcomes were patient activation, self-care ability and unplanned healthcare utilisation. Results Eighty-five patients were recruited and randomised (42 control; 43 intervention). Twenty-three (27%) were lost to follow-up. All patients received their group allocation as randomised and all patients in the intervention group received the web-based education prior to discharge. Postdischarge, patients accessed the education an average of 3 times (SD 3.14), with 4 minutes (SD 16) spent on the website. 28 (97%) of the intervention patients found the content easy to understand, 25 (86%) found it useful and 24 (83%) were satisfied with its content. There was a significant association between the intervention and patient activation ( F( 1,60)=9.347, p=0.003), but not for self-care ability and unplanned healthcare utilisations. Conclusion This pilot study demonstrated the feasibility of implementing a web-based education programme. There was a high number of participants lost to follow-up, requiring additional attention in the design and implementation of a larger trial. Trial registration number ACTRN12620000389909p.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2021-054038
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2599832-8
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  • 5
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    ADding negative pRESSure to improve healING (the DRESSING trial): a RCT protocol
    BMJ ; 2016
    In:  BMJ Open Vol. 6, No. 2 ( 2016-01), p. e010287-
    Details
    In: BMJ Open, BMJ, Vol. 6, No. 2 ( 2016-01), p. e010287-
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2015-010287
    Language: English
    Publisher: BMJ
    Publication Date: 2016
    detail.hit.zdb_id: 2599832-8
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  • 6
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    Online Resource
    Correlates of non-technical skills in surgery: a prospective study
    BMJ ; 2017
    In:  BMJ Open Vol. 7, No. 1 ( 2017-01), p. e014480-
    Details
    In: BMJ Open, BMJ, Vol. 7, No. 1 ( 2017-01), p. e014480-
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2016-014480
    Language: English
    Publisher: BMJ
    Publication Date: 2017
    detail.hit.zdb_id: 2599832-8
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  • 7
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    Closed incision negative pressure wound therapy versus standard dressings in obese women undergoing caesarean section: multicentre parallel group randomised controlled trial
    BMJ ; 2021
    In:  BMJ
    Details
    In: BMJ, BMJ
    Abstract: To determine the effectiveness of closed incision negative pressure wound therapy (NPWT) compared with standard dressings in preventing surgical site infection (SSI) in obese women undergoing caesarean section. Design Multicentre, pragmatic, randomised, controlled, parallel group, superiority trial. Setting Four Australian tertiary hospitals between October 2015 and November 2019. Participants Eligible women had a pre-pregnancy body mass index of 30 or greater and gave birth by elective or semi-urgent caesarean section. Intervention 2035 consenting women were randomised before the caesarean procedure to closed incision NPWT (n=1017) or standard dressing (n=1018). Allocation was concealed until skin closure. Main outcome measures The primary outcome was cumulative incidence of SSI. Secondary outcomes included depth of SSI (superficial, deep, or organ/body space), rates of wound complications (dehiscence, haematoma, seroma, bleeding, bruising), length of stay in hospital, and rates of dressing related adverse events. Women and clinicians were not masked, but the outcome assessors and statistician were blinded to treatment allocation. The pre-specified primary intention to treat analysis was based on a conservative assumption of no SSI for a minority of women (n=28) with missing outcome data. Post hoc sensitivity analyses included best case analysis and complete case analysis. Results In the primary intention to treat analysis, SSI occurred in 75 (7.4%) women treated with closed incision NPWT and in 99 (9.7%) women with a standard dressing (risk ratio 0.76, 95% confidence interval 0.57 to 1.01; P=0.06). Post hoc sensitivity analyses to explore the effect of missing data found the same direction of effect (closed incision NPWT reducing SSI), with statistical significance. Blistering occurred in 40/996 (4.0%) women who received closed incision NPWT and in 23/983 (2.3%) who received the standard dressing (risk ratio 1.72, 1.04 to 2.85; P=0.03). Conclusion Prophylactic closed incision NPWT for obese women after caesarean section resulted in a 24% reduction in the risk of SSI (3% reduction in absolute risk) compared with standard dressings. This difference was close to statistical significance, but it likely underestimates the effectiveness of closed incision NPWT in this population. The results of the conservative primary analysis, multivariable adjusted model, and post hoc sensitivity analysis need to be considered alongside the growing body of evidence of the benefit of closed incision NPWT and given the number of obese women undergoing caesarean section globally. The decision to use closed incision NPWT must also be weighed against the increases in skin blistering and economic considerations and should be based on shared decision making with patients. Trial registration ANZCTR identifier 12615000286549.
    Type of Medium: Online Resource
    ISSN: 1756-1833
    URL: Article
    DOI: 10.1136/bmj.n893
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 1479799-9
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  • 8
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    Older patient participation in discharge medication communication: an observational study
    BMJ ; 2023
    In:  BMJ Open Vol. 13, No. 3 ( 2023-03), p. e064750-
    Details
    In: BMJ Open, BMJ, Vol. 13, No. 3 ( 2023-03), p. e064750-
    Abstract: To describe the extent to which older patients participate in discharge medication communication, and identify factors that predict patient participation in discharge medication communication. Design Observational study. Setting An Australian metropolitan tertiary hospital. Participants 173 older patients were observed undertaking one medication communication encounter prior to hospital discharge. Outcome Patient participation measured with MEDICODE, a valid and reliable coding framework used to analyse medication communication. MEDICODE provides two measures for patient participation: (1) Preponderance of Initiative and (2) Dialogue Ratio. Results The median for Preponderance of Initiative was 0.7 (IQR=0.5–1.0) and Dialogue Ratio was 0.3 (IQR=0.2–0.4), indicating healthcare professionals took more initiative and medication encounters were mostly monologue rather than a dialogue or dyad. Logistic regression revealed that patients had 30% less chance of having dialogue or dyads with every increase in one medication discussed (OR 0.7, 95% CI 0.5 to 0.9, p=0.01). Additionally, the higher the patient’s risk of a medication-related problem, the more initiative the healthcare professionals took in the conversation (OR 1.5, 95% CI 1.0 to 2.1, p=0.04). Conclusion Older patients are passive during hospital discharge medication conversations. Discussing less medications over several medication conversations spread throughout patient hospitalisation and targeting patients at high risk of medication-related problems may promote more active patient participation, and in turn medication safety outcomes.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    URL: Article
    DOI: 10.1136/bmjopen-2022-064750
    DOI: 10.1136/bmjopen-2022-064750.supp1
    Language: English
    Publisher: BMJ
    Publication Date: 2023
    detail.hit.zdb_id: 2599832-8
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