Iatrogenesis

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Eugene Z Oddone - One of the best experts on this subject based on the ideXlab platform.

  • cascade Iatrogenesis factors leading to the development of adverse events in hospitalized older adults
    International Journal of Nursing Studies, 2009
    Co-Authors: Deirdre K Thornlow, Ruth A Anderson, Eugene Z Oddone
    Abstract:

    Older adults are at particular risk for injuries associated with hospitalization and the rate of adverse events increases significantly with age. The purpose of this paper is to review factors associated with the development of adverse events in hospitalized older adults, especially those factors that contribute to cascade Iatrogenesis. Cascade Iatrogenesis is the serial development of multiple medical complications that can be set in motion by a seemingly innocuous first event [Rothschild, J.M., Bates, D.W., Leape, L.L., 2000. Preventable medical injuries in older patients. Archieves of Internal Medicine 160 (October), 2717–2728]. Research has examined how patient characteristics may lead to cascade Iatrogenesis, but existing conceptual models and research have not considered the role of nursing care. Using the outcome postoperative respiratory failure as an example, we expand on existing knowledge about factors associated with older adults’ risk for developing this complication by presenting a conceptual model of events that may trigger the initial cascade and the nursing care variables that may prevent or mitigate these risks. We believe that this model will help guide research in this area and enable clinicians to identify systemic failures and develop targeted interventions to prevent their occurrence.

Diana Coffa - One of the best experts on this subject based on the ideXlab platform.

Deirdre K Thornlow - One of the best experts on this subject based on the ideXlab platform.

  • cascade Iatrogenesis factors leading to the development of adverse events in hospitalized older adults
    International Journal of Nursing Studies, 2009
    Co-Authors: Deirdre K Thornlow, Ruth A Anderson, Eugene Z Oddone
    Abstract:

    Older adults are at particular risk for injuries associated with hospitalization and the rate of adverse events increases significantly with age. The purpose of this paper is to review factors associated with the development of adverse events in hospitalized older adults, especially those factors that contribute to cascade Iatrogenesis. Cascade Iatrogenesis is the serial development of multiple medical complications that can be set in motion by a seemingly innocuous first event [Rothschild, J.M., Bates, D.W., Leape, L.L., 2000. Preventable medical injuries in older patients. Archieves of Internal Medicine 160 (October), 2717–2728]. Research has examined how patient characteristics may lead to cascade Iatrogenesis, but existing conceptual models and research have not considered the role of nursing care. Using the outcome postoperative respiratory failure as an example, we expand on existing knowledge about factors associated with older adults’ risk for developing this complication by presenting a conceptual model of events that may trigger the initial cascade and the nursing care variables that may prevent or mitigate these risks. We believe that this model will help guide research in this area and enable clinicians to identify systemic failures and develop targeted interventions to prevent their occurrence.

Scott Stonington - One of the best experts on this subject based on the ideXlab platform.

Amir Kugelman - One of the best experts on this subject based on the ideXlab platform.

  • Less is More: Modern Neonatology.
    Rambam Maimonides Medical Journal, 2018
    Co-Authors: Amir Kugelman, Liron Borenstein-levin, Huda Jubran, Gil Dinur, Shlomit Ben-david, Elena Segal, Julie Haddad, Fanny Timstut, Iris Shalev Stein, Imad R Makhoul
    Abstract:

    : Iatrogenesis is more common in neonatal intensive care units (NICUs) because the infants are vulnerable and exposed to prolonged intensive care. Sixty percent of extremely low-birth-weight infants are exposed to Iatrogenesis. The risk factors for Iatrogenesis in NICUs include prematurity, mechanical or non-invasive ventilation, central lines, and prolonged length of stay. This led to the notion that "less is more." In the delivery room delayed cord clamping is recommended for term and preterm infants, and suction for the airways in newborns with meconium-stained fluid is not performed anymore. As a symbol for a less aggressive attitude we use the term neonatal stabilization rather than resuscitation. Lower levels of oxygen saturations are accepted as normal during the first 10 minutes of life, and if respiratory assistance is needed, we no longer use 100% oxygen but 0.21-0.3 FiO2, depending on gestational age and the level of oxygen saturation. We try to avoid endotracheal ventilation by using non-invasive respiratory support and administering continuous positive airway pressure early on, starting in the delivery room. If surfactant is needed, non-invasive methods of surfactant administration are utilized. Use of central lines is shortened, and early feeding of human milk is the routine. Permissive hypercapnia is allowed, and continuous non-invasive monitoring not only of the O2 but also of CO2 is warranted. "Kangaroo care" and Newborn Individualized Developmental Care and Assessment Program (NIDCAP) together with a calm atmosphere with parental involvement are encouraged. Whether "less is more," or not enough, is to be seen in future studies.

  • Damaging or Just Inappropriate: The Impact of Rudeness on Medical Team Performance
    Academy of Management Proceedings, 2016
    Co-Authors: Arieh Riskin, Peter A. Bamberger, Amir Kugelman, Ayala Gover, Irit Shoris, Kinneret S Riskin
    Abstract:

    Background and Objective: Iatrogenesis often results from performance deficiencies among medical team members. Team-targeted rudeness may underlie such performance deficiencies with individuals exp...

  • Factors associated with Iatrogenesis in neonatal intensive care units: an observational multicenter study
    European Journal of Pediatrics, 2012
    Co-Authors: Einav Srulovici, Arieh Riskin, Eric S Shinwell, Shmuel Zangen, David Bader, Shraga Blazer, Amir Kugelman
    Abstract:

    The objective of our study was to assess factors associated with iatrogenic events in Neonatal Intensive Care Units (NICUs). This was a retrospective analysis based on a cohort of patients who participated in our previous prospective study ( Pediatrics 122:550–555, 2008), conducted in four tertiary university-affiliated NICUs in Israel, that included all consecutive infants ( n  = 615) hospitalized during the study period. Ongoing monitoring of iatrogenic events was performed by designated “Iatrogenesis advocates.” The main outcome measures were the association of individual infant characteristics and NICUs’ environmental characteristics with iatrogenic events assessed by univariate and multiple logistic regression analysis. We found that four infant characteristics were significantly ( p  

  • Iatrogenesis in neonatal intensive care units observational and interventional prospective multicenter study
    Pediatrics, 2008
    Co-Authors: Amir Kugelman, Arieh Riskin, Esther Inbarsanado, Eric S Shinwell, Imad R Makhoul, Meiron Leshem, Shmuel Zangen, Orly Wattenberg, Tanya Kaplan, David Bader
    Abstract:

    OBJECTIVES. The goals were to determine the incidence of iatrogenic events in NICUs and to determine whether awareness of iatrogenic events could influence their occurrence. METHODS. We performed a prospective, observational, interventional, multicenter study including all consecutive infants hospitalized in 4 NICUs. In the first 3 months (observation period), the medical teams were unaware of the study; in the next 3 months (intervention period), they were made aware of daily ongoing monitoring of iatrogenic events by a designated “Iatrogenesis Advocate.” RESULTS. The numbers of infants admitted to the NICUs were comparable during the observation and intervention periods (328 and 369 infants, respectively). There was no difference between the 2 periods with respect to the number of infants of CONCLUSIONS. Neonatal medical teams and parents should be aware of the burden of Iatrogenesis, which occurs at a significant rate.

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