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2065163
Patient Identification of Diagnostic Safety Blindspots and Participation in “Good Catches” Through Shared Visit Notes
Policy shifts toward health information transparency provide a new opportunity for patients to contribute to diagnostic safety. We investigated whether sharing clinical notes with patients can support identification of “diagnostic safety blindspots”—potentially consequential breakdowns in the diagnostic process that may be difficult for clinical staff to observe.We used mixed methods to analyze patient-reported ambulatory documentation errors among 22,889 patients at three US health care centers who read ≥ 1 visit note(s). We identified blindspots by tailoring a previously established taxonomy. We used multiple regression analysis to identify factors associated with blindspot identification.774 patients reported a total of 962 blindspots in 4 categories: (1) diagnostic misalignments (n = 421, 43.8%), including inaccurate symptoms or histories and failures or delay in diagnosis; (2) errors of omission (38.1%) including missed main concerns or next steps, and failure to listen to patients; (3) problems occurring outside visits (14.3%) such as tests, referrals, or appointment access; and (4) multiple low-level problems (3.7%) cascading into diagnostic breakdowns. Many patients acted on the blindspots they identified, resulting in “good catches” that may prevent potential negative consequences. Older, female, sicker, unemployed or disabled patients, or those who work in health care were more likely to identify a blindspot. Individuals reporting less formal education; those self-identifying as Black, Asian, other, or multiple races; and participants who deferred decision-making to providers were less likely to report a blindspot.Patients who read notes have unique insight about potential errors in their medical records that could impact diagnostic reasoning but may not be known to clinicians—underscoring a critical role for patients in diagnostic safety and organizational learning. From a policy standpoint, organizations should encourage patient review of visit notes, build systems to track patientreported blindspots, and promote equity in note access and blindspot reporting.
Determining the Optimal Harvesting Moment of Green Forage from Guizotia abyssinica Cultivated as a Catch Crop on Silage and Its Quality Form, Fresh or Wilted Green Material, in the Two Following Years.
Simple Summary: Guizotia abyssinica is a plant cultivated mainly in Ethiopian and Indian climate conditions. Its seeds can be used to produce oil or as feed for ornamental birds. In recent years, interest has increased in its use as a catch crop between crops in European conditions. However, owing to its rapid growth rate, attention has also been paid to the possibility of ensiling this plant and using it to prepare feed for cattle after harvesting 58, 68, and 90 days after seed sowing. The results of this research indicate that collecting silage material on the 90th day after sowing allows for the preparation of very good-quality silage. Guizotia abyssinica is currently being used for soil improvement; however, owing to its rapid growth and high productivity, it may have value as feed for ruminants, although this has not been well studied. Thus, this research aimed to evaluate the silage quality of Guizotia abyssinica grown during the short season (July–October) as a catch crop in northern Europe when harvested 58, 68, and 90 days after sowing (DAS) over two production years. Ensiled material was analyzed to compare silage quality for the three different DAS. Two factors were analyzed factorially in the experiment: the silage preparation year (2018 or 2019) and the form of the ensiled material (fresh or wilted). We used 36 replications, 18 for each variant of the experimental factor. Harvesting at 58 DAS resulted in unsatisfactory forage fermentability, even after wilting. At 68 DAS, silage quality was satisfactory, but the dry matter content before ensiling was below 20% for both fresh and wilted forage, indicating limitations for silage use without additional wilting for that DAS harvest time. Dry matter content and water-soluble carbohydrates consistently increased as harvest was delayed. Thus, the highest silage quality was obtained from forage harvested 90 DAS regardless of differences in dry matter content. Therefore, it is possible to prepare silage at lower temperatures when the wilting process is limited by environmental conditions. [ABSTRACT FROM AUTHOR]
Association between weekend catch-up sleep and specific depressive symptoms: a real world research
BackgroundWorkday sleep deprivation has become normalized in contemporary society. While previous research suggested that weekend catch-up sleep (WCS) could reduce the risk of depression, there is currently limited evidence supporting the role of WCS in reducing the development of specific depressive symptoms. Therefore, the objective of this study was to investigate the relationship between WCS and specific depressive symptoms among American.MethodsA total of 7,695 participants were recruited from the 2017–2020 NHANES. Concurrently, an external validation set comprising 180 independent clinical participants from Xijing Hospital was collected. The presence of depressive symptoms was determined through analysis of the PHQ-9 questionnaire, with each item representing one distinct type of depressive symptom. Multivariate logistic regression and generalized additive models were used to determine the correlation between WCS sleep and specific depressive symptoms. Subgroup analysis was used to reveal differences between WCS and specific depressive symptoms in specific populations.ResultsThe findings of the multiple logistic regression analysis indicated that WCS associated with a wide range of specific depressive symptoms, particularly suicidal ideation, with OR = 0.53 (95% CI: 0.33–0.85) in the NHANES group and OR = 0.12 (95% CI: 0.04–0.41) in the clinical sample. Following adjustment for all covariates, non-linear associations of WCS with sleep disturbance and psychomotor disturbance in both samples (NHANES/Xijing Hospital). Furthermore, the results of subgroup analyses indicated that specific subgroups of the vast majority of depressive symptoms were correlated with WCS.ConclusionsThe results of this study confirm that WCS inversely related to specific depressive symptoms, particularly among individuals under 35 with suicidal ideation.