ObjectivesTo provide an overview of whether the clinical decision support system (CDSS) was effective in reducing medication error and improving medication safety and to assess the quality of available scientific evidence.MethodsPubMed, EMbase, The Cochrane Library, CBM, WanFang Data, VIP and CNKI databases were electronically searched to collect systematic reviews (SRs) on application of clinical decision support system in the medication error and safety from January, 1996 to November, 2018. Two reviewers independently screened literature, extracted data and then evaluated methodological quality of included SRs by using AMSTAR tool.g AMSTAR tool.ResultsA total of 20 SRs including 256 980 healthcare practitioners and 1 683 675 patients were included. Specifically, 16 studies demonstrated moderate quality and 4 demonstrated high quality. 19 SRs evaluated multiple process of care outcome: 9 were sufficient evidence, 6 were limited evidence, and 7 were insufficient evidence which proved that CDSS had a positive effect on process outcome. 13 SRs evaluated reported patient outcomes: 1 with sufficient evidence, 3 with limited evidence, and 9 without sufficient evidence.ConclusionsCDSS reduces medication error by inconsistently improving process of care measures and seldom improving patient outcomes. Larger samples and longer-term studies are required to ensure a larger and more reliable evidence base on the effects of CDSS intervention on patient outcomes.
ObjectiveTo systematically review the clinical and genetic features of permanent neonatal diabetes mellitus (PNDM) case reports. MethodsThe PubMed, Embase, Scopus, SinoMed, Web of Science, CINAHL, Medrxiv, VIP, CNKI and WanFang Data databases were electronically searched to collect PNDM case reports from inception to June 2023. Two reviewers independently screened literature, extracted data and assessed the reporting quality of the included studies. Descriptive analysis was performed. ResultsA total of 105 case reports were finally included. Typical clinical manifestations of PNDM were early onset of persistent hyperglycemia, developmental delay and low birth weight. The results of genetic testing showed that mutations in the KCNJ11, INS, EIF2AK3, GCK, ABCC8, PTF1A, GATA6, IER3IP1, SLC19A2, NEUROG3, PDX1, and 6q24 genes were closely associated with the development of PNDM. In addition, there may be different clinical manifestations and prognosis of PNDM in different genotypes. ConclusionThis study reveales the clinical characteristics and genetic pattern of PNDM, and provides a direction for further research on the mechanism of PNDM.
ObjectiveTo investigate and analyze the knowledge, skills and attitudes of clinical medical students and nursing students to patient safety before internship so as to provide evidence for implementation of patient safety curriculum in medical and nursing students. MethodsFive-year clinical medical undergraduates and nursing students before internship in the Wannan Medical College were recruited. The questionnaire method was performed to investigate the knowledge, attitudes and skills of patient safety. The data were input using EpiData 3.0 software and were analyzed by SPSS 13.0. ResultsA total of 771 questionnaires were distributed, of which 320 clinical medical students and 435 nursing students completed the survey. The results showed that, the totals of both kinds of students were low concerning the knowledge, attitudes and skills of patient safety; scores were significantly higher in nursing students than in clinical medical students concerning the items of "Knowledge about medical errors" (P=0.012), "Feelings about making errors" (P=0.000), "Feelings about making errors" (P=0.001), and "Personal attitudes to patient safety" (P=0.001). Scores of "Feelings about making errors" were significantly higher in female students than in male students. ConclusionBoth nursing students and clinical medical students lack the knowledge of patient safety before internship, and the latter lack more. More attention should be paid to the knowledge of patient safety for both clinical medical and nursing students.
ObjectiveTo investigate and analyze the knowledge, skills and attitudes of nursing students to patient safety before and after internship so as to provide evidence for implementation of patient safety curriculum in nursing students. MethodsUndergraduate nursing students before and after internship in nursing school of Wannan Medical College were recruited. The questionnaire method was performed to investigate the knowledge, attitudes and skills of patient safety before and after the internship. The data were input using EpiData 3.0 software and were analyzed by SPSS 13.0. ResultsA total of 451 questionnaires were distributed before the internship and of which 435 nursing students completed the survey (96.45%), 418 questionnaires were distributed after the internship, of which 412 (98.56%) nursing students completed the survey. There were significant higher scores in female nursing students after the internship in the items of 'Knowledge about medical errors' and 'What am I supposed to do when medical errors occur' (P=0.000 and 0.000, respectively), while lower scores of the items of 'Feelings about making errors' and 'Your intentions regarding patient safety' (P=0.002 and 0.006, respectively). Only the score of the item 'What am I supposed to do when medical errors occur' was significantly higher in male nursing students after the internship (P=0.046). ConclusionThe internship is useful for improving experiencing practice, knowledge on patient safety, reduce the negative feelings about making errors.
ObjectiveTo explore the effect of patient safety education course on the undergraduate nursing students in terms of knowledge, attitude and skills about patient safety. MethodsWe enrolled five-year undergraduates admitted to Wannan Medical College in 2009. Eighty two nursing students who took part in the elective course of patient safety education course at the first semester of the seniors were selected as the observation group; while the other 359 nursing students who did not took part in the course were selected as the control group. The questionnaire method was performed to investigate the knowledge, attitude and skills about patient safety before and after the course. ResultsThere were significant higher scores in the observation group than in the control group in the following domains:"Knowledge of medical errors" and "What should I do after medical errors occur?". ConclusionSetting up "patient safety education" course could significantly improve the knowledge, attitude and skills about patient safety for undergraduate nursing students.
Dose-response meta-analysis serves an important role in investigating the dose-response relationship between independent variables (e.g. dosage) and disease outcomes. Traditional dose-response meta-analysis model is based on one independent variable to consider its own dose-specific effect on the outcome. However, for drug clinical trials, it generally involves two-dimensions of the treatment, such as dosage and course of treatment. These two-dimensions tend to be associated with each other. When neglecting their correlations, the results may be at risk of bias. Moreover, taking account of the "combined effect” of dosage and time on outcome has more clinical value. Therefore, in this article, based on traditional dose-response meta-analysis model, we propose a three-dimension model for dose-response meta-analysis which considers both the effect of dosage and time, to provide a solution for the above-mentioned problems in a traditional model.