News Article | May 11, 2017
According to the survey, released by the Massachusetts Nurses Association at the State House on May 11, having too many patients at one time to care for is the most significant challenge to RNs providing high-quality patient care, with 77 percent of nurses identifying unsafe patient assignments as a problem. The survey also shows that patients are sicker than ever before, requiring highly specialized nursing care. To help educate the public about the role of RNs in today's complex health care environment, the MNA also premiered at the State House a video series called "What Nurses Really Do" alongside the survey. The first video and a call to action for more nurse videos can be seen at www.massnurses.org/WhatNursesDo. "When it comes to the delivery of patient care and the safety of patients, registered nurses are at the front lines of the health care system," said MNA President Donna Kelly-Williams, RN. "What happens to nurses and the nursing profession is directly connected to the ultimate health and well-being of every patient we encounter. In hospitals, nurses deliver 90 percent of the clinical care patients receive, and are the only caregivers legally and ethically accountable for the safety of patients every minute they are in the hospital." Nurses providing direct care report their patients have increased medical complications and are admitted to the hospital with more serious illness and injury today. Wide majorities of nurses – nearly eight-in-ten – say their patients are sicker now than patients ten years ago. More than half (53%) say their patients are much sicker – a figure that jumps to 63% among nurses working at community hospitals. Twice as many nurses say the staffing situation in their facility has gotten worse over the past four years (39%) as say it has gotten better (21%). Staffing issues are particularly problematic at community hospitals (8% gotten better, 41% gotten worse). Just one-in-ten nurses (10%) feels administrators at their hospital are very responsive to input from RNs about patient assignment levels. Three-in-ten (28%) say management rarely or never adjusts nurse staffing levels when RNs face unsafe patient loads. In each of these categories, RNs reported an increase in patient safety concern over 2015 survey results: "Our nurses are telling us that things are not working," said Rep. Denise Garlick, D-Needham. "We need to listen to them. Three years ago, I worked with my colleagues in the House and Senate to pass safe patient limits in our Intensive Care Units, knowing that it was the first step towards limits in all hospital units. Today's survey confirms that we must take that next step. Our nurses are telling us we need safe limits in all units to protect patients." By wide margins, nurses are more likely to say hospital mergers and acquisitions (21-point margin) and emerging business relationships between hospitals and pharmaceutical companies and/or medical device manufacturers (19-point margin) worsen the quality of patient care. Nurses are even more critical of the impact of insurance reimbursement changes, saying new insurance policies do more to worsen care by a 33-point margin. What Nurses Really Do For 15 straight years, nurses have topped Gallup's annual survey of the most honest and trustworthy professions. But many people don't really know what nurses do on a daily basis. "The State of Nursing in Massachusetts" shows that 43 percent of RNs do not believe patients understand their role. The reality is that nursing today is a complex and demanding profession. Patients are sicker than ever and are admitted to hospitals with serious medical complications. The MNA's video series, "What Nurses Really Do" features Massachusetts nurses speaking directly to the public, telling them about the specialized patient care they provide every day. The first installment in the series, debuting May 11 at the State House, features RNs from Cape Cod Hospital, Norwood Hospital and Brigham and Women's Faulkner Hospital. Nurses are encouraged to share their own experiences as nurses and tell the public what they really do at www.massnurses.org/WhatNursesDo. "The State of Nursing in Massachusetts" was commissioned by the MNA and conducted between April 5 and April 25, 2017 by Anderson Robbins Research, an independent research firm headquartered in Boston. The 2017 survey respondents were all registered nurses working in Massachusetts health care facilities randomly selected from a complete file of the 100,000 nurses registered with the Massachusetts Board of Registration in Nursing. Founded in 1903, the Massachusetts Nurses Association is the largest union of registered nurses in the Commonwealth of Massachusetts. Its 23,000 members advance the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Legislature and regulatory agencies on health care issues affecting nurses and the public. To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/state-of-nursing-in-massachusetts-survey-released-for-national-nurses-week---results-strike-alarm-for-patient-safety-amid-drastic-changes-to-health-care-300456133.html
Poon E.G.,Brigham and Women's Hospital |
Poon E.G.,Harvard University |
Keohane C.A.,Brigham and Women's Hospital |
Yoon C.S.,Brigham and Women's Hospital |
And 17 more authors.
New England Journal of Medicine | Year: 2010
BACKGROUND: Serious medication errors are common in hospitals and often occur during order transcription or administration of medication. To help prevent such errors, technology has been developed to verify medications by incorporating bar-code verification technology within an electronic medication-administration system (bar-code eMAR). METHODS: We conducted a before-and-after, quasi-experimental study in an academic medical center that was implementing the bar-code eMAR. We assessed rates of errors in order transcription and medication administration on units before and after implementation of the bar-code eMAR. Errors that involved early or late administration of medications were classified as timing errors and all others as nontiming errors. Two clinicians reviewed the errors to determine their potential to harm patients and classified those that could be harmful as potential adverse drug events. RESULTS: We observed 14,041 medication administrations and reviewed 3082 order transcriptions. Observers noted 776 nontiming errors in medication administration on units that did not use the bar-code eMAR (an 11.5% error rate) versus 495 such errors on units that did use it (a 6.8% error rate) - a 41.4% relative reduction in errors (P<0.001). The rate of potential adverse drug events (other than those associated with timing errors) fell from 3.1% without the use of the bar-code eMAR to 1.6% with its use, representing a 50.8% relative reduction (P<0.001). The rate of timing errors in medication administration fell by 27.3% (P<0.001), but the rate of potential adverse drug events associated with timing errors did not change significantly. Transcription errors occurred at a rate of 6.1% on units that did not use the barcode eMAR but were completely eliminated on units that did use it. CONCLUSIONS: Use of the bar-code eMAR substantially reduced the rate of errors in order transcription and in medication administration as well as potential adverse drug events, although it did not eliminate such errors. Our data show that the bar-code eMAR is an important intervention to improve medication safety. Copyright © 2010 Massachusetts Medical Society.
Webber T.A.,Tufts University |
Webber A.E.,Faulkner Hospital |
Matzkin E.,Brigham and Women's Hospital
Orthopedics | Year: 2012
Viscosupplementation, hyaluronic acid treatment, is an ancillary method for treating patients with symptomatic stage I or II osteoarthritis. Previous studies reported that local reactions occurred more frequently in patients receiving >1 course of treatment compared with patients receiving their first course of treatment. One (2%) of 42 first series patients and 4 (21%) of 19 of repeated series patients had adverse reactions severe enough to seek unscheduled care. This study was performed to determine whether patients receiving >1 series of viscosupplementation had an increased adverse reaction rate. A retrospective chart review was performed on all patients who received >.1 series of viscosupplementation during the study. A local adverse reaction was defined as acute swelling and pain in the knee, with no injury or trauma within 72 hours after hyaluronic acid injection. Twenty-eight knees received >1 series of viscosupplementation. The adverse reaction rate to second series injections was 1.28% (3.57% of knees). The adverse reaction rate to ≥3 series was 0.9% (6.67% of knees). This adverse reaction rate was significantly less than the 21% reported in previous studies for multiple series injections (z521.90; P<.05) and is not significantly different than the 2% rate of adverse reactions reported for first series injections. No significant difference existed in the adverse reaction rates between 2 series and ≥3 series of viscosupplementation. The current study suggests that the rate of adverse reaction was low at 1.28% of second series viscosupplementation.
Childs S.K.,Harvard University |
Chen Y.-H.,Dana-Farber Cancer Institute |
Duggan M.M.,Faulkner Hospital |
Duggan M.M.,Dana-Farber Cancer Institute |
And 5 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2013
Purpose: To examine the rate of local recurrence according to the margin status for patients with pure ductal carcinoma in situ (DCIS) treated by mastectomy. Methods and Materials: One hundred forty-five consecutive women who underwent mastectomy with or without radiation therapy for DCIS from 1998 to 2005 were included in this retrospective analysis. Only patients with pure DCIS were eligible; patients with microinvasion were excluded. The primary endpoint was local recurrence, defined as recurrence on the chest wall; regional and distant recurrences were secondary endpoints. Outcomes were analyzed according to margin status (positive, close (≤2 mm), or negative), location of the closest margin (superficial, deep, or both), nuclear grade, necrosis, receptor status, type of mastectomy, and receipt of hormonal therapy. Results: The primary cohort consisted of 142 patients who did not receive postmastectomy radiation therapy (PMRT). For those patients, the median follow-up time was 7.6 years (range, 0.6-13.0 years). Twenty-one patients (15%) had a positive margin, and 23 patients (16%) had a close (≤2 mm) margin. The deep margin was close in 14 patients and positive in 6 patients. The superficial margin was close in 13 patients and positive in 19 patients. One patient experienced an isolated invasive chest wall recurrence, and 1 patient had simultaneous chest wall, regional nodal, and distant metastases. The crude rates of chest wall recurrence were 2/142 (1.4%) for all patients, 1/21 (4.8%) for those with positive margins, 1/23 (4.3%) for those with close margins, and 0/98 for patients with negative margins. PMRT was given as part of the initial treatment to 3 patients, 1 of whom had an isolated chest wall recurrence. Conclusions: Mastectomy for pure DCIS resulted in a low rate of local or distant recurrences. Even with positive or close mastectomy margins, the rates of chest wall recurrences were so low that PMRT is likely not warranted. © 2013 Elsevier Inc. All rights reserved.
Strauss L.,Brigham and Women's Hospital |
Strauss L.,Faulkner Hospital |
Loder E.,Brigham and Women's Hospital |
Loder E.,Faulkner Hospital |
And 2 more authors.
Headache | Year: 2014
Occipital nerve blocks are commonly performed to treat a variety of headache syndromes and are generally believed to be safe and well tolerated.We report the case of an otherwise healthy 24-year-old woman with left side-locked occipital, parietal, and temporal pain who was diagnosed with probable occipital neuralgia. She developed complete left facial nerve palsy within minutes of blockade of the left greater and lesser occipital nerves with a solution of bupivicaine and triamcinolone. Magnetic resonance imaging of the brain with gadolinium contrast showed no abnormalities, and symptoms had completely resolved 4-5 hours later. Unintended spread of the anesthetic solution along tissue planes seems the most likely explanation for this adverse event. An aberrant course of the facial nerve or connections between the facial and occipital nerves also might have played a role, along with the patient's prone position and the use of a relatively large injection volume of a potent anesthetic. Clinicians should be aware that temporary facial nerve palsy is a possible complication of occipital nerve block. © 2014 American Headache Society.
Onishi M.,Okayama University of Science |
Ichikawa T.,Okayama University of Science |
Kurozumi K.,Okayama University of Science |
Fujii K.,Okayama University of Science |
And 6 more authors.
Neuropathology | Year: 2013
Integrins are expressed in tumor cells and tumor endothelial cells, and likely play important roles in glioma angiogenesis and invasion. We investigated the anti-glioma mechanisms of cilengitide (EMD121974), an αvβ3 integrin inhibitor, utilizing the novel invasive glioma models, J3T-1 and J3T-2. Immunohistochemical staining of cells in culture and brain tumors in rats revealed positive αvβ3 integrin expression in J3T-2 cells and tumor endothelial cells, but not in J3T-1 cells. Established J3T-1 and J3T-2 orthotopic gliomas in athymic rats were treated with cilengitide or solvent. J3T-1 gliomas showed perivascular tumor cluster formation and angiogenesis, while J3T-2 gliomas showed diffuse single-cell infiltration without obvious angiogenesis. Cilengitide treatment resulted in a significantly decreased diameter of the J3T-1 tumor vessel clusters and its core vessels when compared with controls, while an anti-invasive effect was shown in the J3T-2 glioma with a significant reduction of diffuse cell infiltration around the tumor center. The survival of cilengitide-treated mice harboring J3T-1 tumors was significantly longer than that of control animals (median survival: 57.5 days and 31.8 days, respectively, P<0.005), while cilengitide had no effect on the survival of mice with J3T-2 tumors (median survival: 48.9 days and 48.5, P=0.69). Our results indicate that cilengitide exerts a phenotypic anti-tumor effect by inhibiting angiogenesis and glioma cell invasion. These two mechanisms are clearly shown by the experimental treatment of two different animal invasive glioma models. © 2012 Japanese Society of Neuropathology.
Masciari S.,Dana-Farber Cancer Institute |
Dillon D.A.,Brigham and Women's Hospital |
Rath M.,Dana-Farber Cancer Institute |
Robson M.,Sloan Kettering Cancer Center |
And 10 more authors.
Breast Cancer Research and Treatment | Year: 2012
Breast cancer is the most common tumor in women with Li-Fraumeni Syndrome (LFS), an inherited cancer syndrome associated with germline mutations in the TP53 tumor suppressor gene. Their lifetime breast cancer risk is 49% by age 60. Breast cancers in TP53 mutation carriers recently have more often been reported to be hormone receptor and HER-2 positive by immunohisto-chemistry and FISH in small series. We seek to complement the existing small literature with this report of a histopath-ologic analysis of breast cancers from women with documented LFS. Unstained slides and paraffin-embedded tumor blocks from breast cancers from 39 germline TP53 mutation carriers were assembled from investigators in the LFS consortium. Central histology review was performed on 93% of the specimens by a single breast pathologist from a major university hospital. Histology, grade, and hormone receptor status were assessed by immunohistochemistry; HER-2 status was defined by immunohistochemistry and/or FISH. The 43 tumors from 39 women comprise 32 invasive ductal carcinomas and 11 ductal carcinomas in situ (DCIS). No other histologies were observed. The median age at diagnosis was 32 years (range 22-46). Of the invasive cancers, 84% were positive for ER and/or PR; and 81% were high grade. Sixty three percent of invasive and 73% of in situ carcinomas were positive for Her2/neu (IHC 3+ or FISH amplified). Of the invasive tumors, 53% were positive for both ER and HER2+; other ER/PR/HER2 combinations were observed. The DCIS were positive for ER and HER2 in 27% of the cases. This report of the phenotype of breast cancers from women with LFS nearly doubles the literature on this topic. Most DCIS and invasive ductal carcinomas in LFS are hormone receptor positive and/or HER-2 positive. These findings suggest that modern treatments may result in improved outcomes for women with LFS-associated breast cancer. © 2012 Springer Science+Business Media, LLC.
Buck M.,Veterans Affairs San Diego Healthcare System |
Buck M.,University of California at San Diego |
Garcia-Tsao G.,Veterans Affairs Connecticut Healthcare System |
Garcia-Tsao G.,Yale University |
And 10 more authors.
Hepatology | Year: 2014
The rationale for screening inflammatory serum biomarkers of the hepatic vein pressure gradient (HVPG) is based on the fact that portal hypertension is pathogenically related to liver injury and fibrosis, and that in turn these are associated with the activation of inflammatory pathways. This was a nested cohort study in the setting of a randomized, clinical trial to assess the development of gastroesophageal varices (GEV) (N Engl J Med 2005;353:2254). Patients had cirrhosis and portal hypertension but did not have GEV. A total of 90 patients who had baseline day-1 sera available were enrolled in the present study. The objective of this study was to determine whether inflammatory biomarkers in conjunction with clinical parameters could be used to develop a predictive paradigm for HVPG. The correlations between HVPG and interleukin (IL)-1β (P=0.0052); IL-1R-α (P=0.0085); Fas-R (P=0.0354), and serum VCAM-1 (P=0.0007) were highly significant. By using multivariate logistic regression analysis and selected parameters (transforming growth factor beta [TGFβ]; heat shock protein [HSP]-70; at-risk alcohol use; and Child class B) we could exclude HVPG ≥12 mmHg with 86% accuracy (95% confidence interval [CI]: 67.78 to 96.16%) and the sensitivity was 87.01% (95% CI: 69.68 to 96.34%). Therefore, the composite test could identify 86% of compensated cirrhosis patients with HVPG below 12 mmHg and prevent unnecessary esophagogastroduodenoscopy with its associated morbidity and costs in these patients. Our diagnostic test was not efficient in predicting HVPG ≥12 mmHg. Conclusion: A blood test for HVPG could be performed in cirrhosis patients to prevent unnecessary esophagogastroduodenoscopy. © 2014 by the American Association for the Study of Liver Diseases.
Childs S.K.,Harvard University |
Chen Y.-H.,Dana-Farber Cancer Institute |
Duggan M.M.,Faulkner Hospital |
Duggan M.M.,Brigham and Women's Hospital |
And 4 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2012
Purpose: Although positive surgical margins are generally associated with a higher risk of local-regional recurrence (LRR) for most solid tumors, their significance after mastectomy remains unclear. We sought to clarify the influence of the mastectomy margin on the risk of LRR. Methods and Materials: The retrospective cohort consisted of 397 women who underwent mastectomy and no radiation for newly diagnosed invasive breast cancer from 1998-2005. Time to isolated LRR and time to distant metastasis (DM) were evaluated by use of cumulative-incidence analysis and competing-risks regression analysis. DM was considered a competing event for analysis of isolated LRR. Results: The median follow-up was 6.7 years (range, 0.5-12.8 years). The superficial margin was positive in 41 patients (10%) and close (≤2 mm) in 56 (14%). The deep margin was positive in 23 patients (6%) and close in 34 (9%). The 5-year LRR and DM rates for all patients were 2.4% (95% confidence interval, 0.9-4.0) and 3.5% (95% confidence interval, 1.6-5.3) respectively. Fourteen patients had an LRR. Margin status was significantly associated with time to isolated LRR (P=.04); patients with positive margins had a 5-year LRR of 6.2%, whereas patients with close margins and negative margins had 5-year LRRs of 1.5% and 1.9%, respectively. On univariate analysis, positive margins, positive nodes, lymphovascular invasion, grade 3 histology, and triple-negative subtype were associated with significantly higher rates of LRR. When these factors were included in a multivariate analysis, only positive margins and triple-negative subtype were associated with the risk of LRR. Conclusions: Patients with positive mastectomy margins had a significantly higher rate of LRR than those with a close or negative margin. However, the absolute risk of LRR in patients with a positive surgical margin in this series was low, and therefore the benefit of postmastectomy radiation in this population with otherwise favorable features is likely to be small. © 2012 Elsevier Inc. All rights reserved.
PubMed | Miraca Life science, Brigham and Women's Hospital, Yale University, Boston Medical Center and Faulkner Hospital
Type: Journal Article | Journal: Human pathology | Year: 2015
There is evidence that some cancers in patients with inflammatory bowel disease (IBD) develop via the serrated pathway of carcinogenesis. This study examined the clinicopathological features and outcome of 115 IBD patients (65 with ulcerative colitis, 50 with Crohn disease), all with at least 1 serrated polyp at endoscopy or colon resection, including the presence of synchronous and metachronous conventional neoplastic lesions (dysplasia or adenocarcinoma), over an average follow-up period of 56.4 months. Conventional neoplasia was categorized as flat dysplasia (low or high grade), sporadic adenoma, adenoma-like dysplasia-associated lesion or mass, or adenocarcinoma. Overall, 97% of patients had at least 1 hyperplastic polyp (HP), 6% had a sessile serrated adenoma/polyp, and none had a traditional serrated adenoma. Eight patients (7%) had a synchronous conventional neoplastic lesion; only 1 had flat dysplasia (1%) and 2 had adenocarcinoma (2%). Thirteen patients developed a metachronous conventional neoplastic lesion, with 8 developing their conventional neoplasm within an area of previous or concurrent colitis; only 1 patient developed flat dysplasia (1%), and none developed adenocarcinoma. A higher proportion of patients with both an HP and a synchronous conventional neoplastic lesion at index developed a metachronous conventional neoplastic lesion, compared with those with an index HP only (25% versus 7%). These results suggest that IBD patients (both ulcerative colitis and Crohn disease patients) with HP have a very low risk of developing a conventional neoplastic lesion (flat dysplasia or adenocarcinoma) that would warrant surgical resection.