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1501. The Emergence of the Trigger Tool as the Premier Measurement Strategy for Patient Safety | PSNet
      psnet.ahrq.gov/perspective/emergence-trigger-tool-premier-measurement-strategy-patient-safety
      May 01, 2012 - estimated that avoidable medical errors contribute to 44,000–98,000 deaths, and more than a million injuries … Patient safety efforts should focus on medical injuries. JAMA. 2002;287:1993-1997. … detection of adverse events in hospital patients, and it moves patient safety from a retrospective focus on injury … a really important transition to make, and it's going to be hard because it's going to put a lot of pressure

1502. In Conversation With…David C. Classen, MD, MS | PSNet
      psnet.ahrq.gov/perspective/conversation-withdavid-c-classen-md-ms
      May 01, 2012 - detection of adverse events in hospital patients, and it moves patient safety from a retrospective focus on injury … a really important transition to make, and it's going to be hard because it's going to put a lot of pressure … estimated that avoidable medical errors contribute to 44,000–98,000 deaths, and more than a million injuries … Patient safety efforts should focus on medical injuries. JAMA. 2002;287:1993-1997.

1503. Microsoft Word - 3-DKE274__ACEI-ARB-DRI__Comments_Disposition_Table-21_Jan_2011 cyk _2_.docx (pdf file)
      effectivehealthcare.ahrq.gov/sites/default/files/related_files/ace-inhibitor-arb-update_disposition-comments.pdf
      October 07, 2011 - the second and third trimesters, drugs that act directly on the renin angiotensin system can cause injury … This would be appropriate for blood pressure control and perhaps for adherence to medication and common … Some of our outcomes of interest, such as blood pressure lowering or medication side effects, could

1504. Facilitator Guide: Optimize Your Briefings and Debriefings (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/modules/implementation/imp_opt_briefings_facnotes.docx
      December 01, 2017 - defines a sentinel event as an unexpected occurrence involving death or serious physical or psychological injury … Serious injury specifically includes loss of limb or function. … Review the perfusion plan, including cannulation, perfusion pressure goals, temperature, and transfusion

1505. Optimize Briefings and Debriefings: Facilitator Notes | Agency for Healthcare Research and Quality
      www.ahrq.gov/hai/tools/surgery/modules/implementation/opt-briefings-fac-notes.html
      December 01, 2017 - defines a sentinel event as an unexpected occurrence involving death or serious physical or psychological injury … Serious injury specifically includes loss of limb or function. … Review the perfusion plan, including cannulation, perfusion pressure goals, temperature, and transfusion

1506. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/61083/psn-pdf
      October 28, 2020 - In putting all of this in place, did you see reductions in harms like pressure injuries, resident falls

1507. Final Progress Report: Short-term Clinical Deterioration After Acute Pulmonary Embolism (pdf file)
      www.ahrq.gov/sites/default/files/2025-02/weekes-report.pdf
      January 01, 2025 - important indicator of acute PE of moderate to high severity is an acute increase in right ventricular pressure … abnormality is commonly assessed in two ways: 1) laboratory surrogates of myocardial stretch and injury … and 2) imaging assessments for RV dilatation, pressure increases, and decreased systolic function. … point each for abnormal RV by echocardiography, abnormal RV by computed tomography, systolic blood pressure

1508. Cesarean Delivery for Nulliparous (NTSV) Women (Appropriate Use) (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/perinatal/chipra-0082-fullreport.pdf
      March 01, 2016 - delivery are at much higher risk for rehospitalization for uterine infection and obstetrical surgical wound … nonmedical factors such as provider density, the capacity of the local health care system, and malpractice pressure … o Have a physical abnormality or injury to their brain or spinal cord. … For example, there may be fewer surgical injuries and fewer infections. … vaginally is more likely to have a nerve injury that affects the shoulder, arm, or hand.

1509. Duty to Disclose Someone Else's Error? | PSNet
      psnet.ahrq.gov/web-mm/duty-disclose-someone-elses-error
      June 01, 2004 - ICU, he was noted to have fixed and dilated pupils on neurologic exam, a sign of serious neurologic injury … Strong psychological pressures accompanying these events (not wanting to admit a mistake) can bias the

1510. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/50754/psn-pdf
      December 18, 2019 - an unwanted resuscitation with extreme consequences, including CPR- related fractures, anoxic brain injury … establishing more humane working hours during postgraduate training, residents are still often under great pressure

1511. Prevention, Diagnosis, and Management of Opioids, Opioid Misuse and Opioid Use Disorder in Older Adults: Protocol (pdf file)
      effectivehealthcare.ahrq.gov/sites/default/files/pdf/opioids-oa-protocol.pdf
      June 29, 2019 - Risk of injury associated with opioid use in older adults. … Meta-analysis of cyclooxygenase-2 inhibitors and their effects on blood pressure. … Effects of COX inhibition on blood pressure and kidney function in ACE inhibitor-treated blacks and

1512. Diabetes-Related Inpatient Stays, 2018 (pdf file)
      hcup-us.ahrq.gov/reports/statbriefs/sb279-Diabetes-Inpatient-Stays-2018.pdf
      January 01, 2018 - The unspecif ic category Complication of other surgical or medical care, injury, initial encounter is … complications* —† —† 3 41.1 Essential hypertension 5 21.2 4 40.1 Chronic kidney disease 10 16.4 5 35.8 Pressure … stays for type 2 but not type 1 diabetes: hypertension with complications and secondary hypertension, pressure

1513. Post-Acute Transitional Services: Safety in Home-Based Care Programs | PSNet
      psnet.ahrq.gov/primer/post-acute-transitional-services-safety-home-based-care-programs
      April 24, 2024 - low socioeconomic status are at particularly high risk for poor outcomes such as medication errors, injuries … Medicare & Medicaid Services (CMS) defines homebound as being confined to the home due to an illness or injury … Improving blood pressure control using smart technology.

1514. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/836941/psn-pdf
      April 27, 2022 - low socioeconomic status are at particularly high risk for poor outcomes such as medication errors, injuries … Medicare & Medicaid Services (CMS) defines homebound as being confined to the home due to an illness or injury … Improving blood pressure control using smart technology. Telemed J E Health. 2018;24(3):222-228.

1515. "Do You Want Everything Done?": Clarifying Code Status | PSNet
      psnet.ahrq.gov/web-mm/do-you-want-everything-done-clarifying-code-status
      March 27, 2024 - an unwanted resuscitation with extreme consequences, including CPR-related fractures, anoxic brain injury … establishing more humane working hours during postgraduate training, residents are still often under great pressure … review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma

1516. The San Diego Center for Patient Safety: Creating a Research, Education, and Community Consortium (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Pratt.pdf
      March 01, 2004 - The usual time Advances in Patient Safety: Vol. 4 36 pressures and competing demands kept early … identification and wrong-site surgery; (3) event reporting, including near misses; and (4) physical injury … As the collaborative and Consortium have grown, there has been increasing pressure to take on new initiatives

1517. Interventions To Prevent Age-Related Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer’s-Type Dementia (pdf file)
      effectivehealthcare.ahrq.gov/sites/default/files/related_files/cognitive-decline_executive.pdf
      March 01, 2017 - forms of dementia (such as Lewy body disease, infectious disease, frontotemporal, traumatic brain injury … identifiable conditions such as Lewy body, infectious diseases, frontotemporal, and traumatic brain injury … Thus, the findings may underestimate the effects of controlling blood pressure on dementias as a whole … these positive outcomes can be viewed as a potential additional benefit from efforts to control blood pressure

1518. Interventions To Prevent Age-Related Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer’s-Type Dementia (pdf file)
      effectivehealthcare.ahrq.gov/sites/default/files/pdf/cognitive-decline_executive.pdf
      March 01, 2017 - forms of dementia (such as Lewy body disease, infectious disease, frontotemporal, traumatic brain injury … identifiable conditions such as Lewy body, infectious diseases, frontotemporal, and traumatic brain injury … Thus, the findings may underestimate the effects of controlling blood pressure on dementias as a whole … these positive outcomes can be viewed as a potential additional benefit from efforts to control blood pressure

1519. Disposition of Comments for CER 151 Management of Postpartum Hemorrhage (pdf file)
      effectivehealthcare.ahrq.gov/sites/default/files/related_files/hemorrhage-postpartum_disposition-comments.pdf
      April 28, 2015 - The correct term is probably “injury” or “damage” for both bladder and ureteral injury. … 900 ml or up to 20% of the circulating blood volume cause no change in either the maternal blood pressure … Maternal tachycardia is present (100-120 beats/min and maternal hypotension (systolic blood pressure

1520. Archived: Final Evidence Summary: Carotid Artery Stenosis: Screening, December 2007 | United States Preventive Services Taskforce
      www.uspreventiveservicestaskforce.org/uspstf/document/final-evidence-summary11/carotid-artery-stenosis-screening-december-2007
      December 15, 2007 - Although it is difficult to determine the intensity of medical management, the mean systolic blood pressure … However, among the RCTs, the VACS reported a surgical complications rate of 3.8% for cranial nerve injuries … (none of these injuries were permanent), 5.2% for hypotension, and 25% for hypertension. 34 Return … Cumulative effects of high cholesterol levels, high blood pressure, and cigarette smoking on carotid … Overall=3.7% High volume hospital (>100 cases/year) = 3.5% Low volume hospital=5.2% 3% HTN 2% wound