108 resultados para Diagnostic Errors


Relevância:

20.00% 20.00%

Publicador:

Resumo:

Airborne laser altimetry has the potential to make frequent detailed observations that are important for many aspects of studying land surface processes. However, the uncertainties inherent in airborne laser altimetry data have rarely been well measured. Uncertainty is often specified as generally as 20cm in elevation, and 40cm planimetric. To better constrain these uncertainties, we present an analysis of several datasets acquired specifically to study the temporal consistency of laser altimetry data, and thus assess its operational value. The error budget has three main components, each with a time regime. For measurements acquired less than 50ms apart, elevations have a local standard deviation in height of 3.5cm, enabling the local measurement of surface roughness of the order of 5cm. Points acquired seconds apart acquire an additional random error due to Differential Geographic Positioning System (DGPS) fluctuation. Measurements made up to an hour apart show an elevation drift of 7cm over a half hour. Over months, this drift gives rise to a random elevation offset between swathes, with an average of 6.4cm. The RMS planimetric error in point location was derived as 37.4cm. We conclude by considering the consequences of these uncertainties on the principle application of laser altimetry in the UK, intertidal zone monitoring.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

Three existing models of Interplanetary Coronal Mass Ejection (ICME) transit between the Sun and the Earth are compared to coronagraph and in situ observations: all three models are found to perform with a similar level of accuracy (i.e. an average error between observed and predicted 1AU transit times of approximately 11 h). To improve long-term space weather prediction, factors influencing CME transit are investigated. Both the removal of the plane of sky projection (as suffered by coronagraph derived speeds of Earth directed CMEs) and the use of observed values of solar wind speed, fail to significantly improve transit time prediction. However, a correlation is found to exist between the late/early arrival of an ICME and the width of the preceding sheath region, suggesting that the error is a geometrical effect that can only be removed by a more accurate determination of a CME trajectory and expansion. The correlation between magnetic field intensity and speed of ejecta at 1AU is also investigated. It is found to be weak in the body of the ICME, but strong in the sheath, if the upstream solar wind conditions are taken into account.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

Rationale: In UK hospitals, the preparation of all total parenteral nutrition (TPN) products must be made in the pharmacy as TPNs are categorised as high-risk injectables (NPSA/2007/20). The National Aseptic Error Reporting Scheme has been collecting data on pharmacy compounding errors in the UK since August 2003. This study reports on types of error associated with the preparation of TPNs, including the stage at which these were identified and potential and actual patient outcomes. Methods: Reports of compounding errors for the period 1/2004 - 3/2007 were analysed on an Excel spreadsheet. Results: Of a total of 3691 compounding error reports, 674 (18%) related to TPN products; 548 adult vs. 126 paediatric. A significantly higher proportion of adult TPNs (28% vs. 13% paediatric) were associated with labelling errors and a significantly higher proportion of paediatric TPNs (25% vs. 15% adult) were associated with incorrect transcriptions (Chi-Square Test; p<0.005). Labelling errors were identified equally by pharmacists (42%) and technicians (48%) with technicians detecting mainly at first check and pharmacists at final check. Transcription errors were identified mainly by technicians (65% vs. 27% pharmacist) at first check. Incorrect drug selection (13%) and calculation errors (9%) were associated with adult and paediatric TPN preparations in the same ratio. One paediatric TPN error detected at first check was considered potentially catastrophic; 31 (5%) errors were considered of major and 38 (6%) of moderate potential consequence. Five errors (2 moderate, 1 minor) were identified during or after administration. Conclusions: While recent UK patient safety initiatives are aimed at improving the safety of injectable medicines in clinical areas, the current study highlights safety problems that exist within pharmacy production units. This could be used in the creation of an error management tool for TPN compounding processes within hospital pharmacies.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

Objectives: To assess the impact of a closed-loop electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration record (EMAR) system on prescribing and administration errors, confirmation of patient identity before administration, and staff time. Design, setting and participants: Before-and-after study in a surgical ward of a teaching hospital, involving patients and staff of that ward. Intervention: Closed-loop electronic prescribing, automated dispensing, barcode patient identification and EMAR system. Main outcome measures: Percentage of new medication orders with a prescribing error, percentage of doses with medication administration errors (MAEs) and percentage given without checking patient identity. Time spent prescribing and providing a ward pharmacy service. Nursing time on medication tasks. Results: Prescribing errors were identified in 3.8% of 2450 medication orders pre-intervention and 2.0% of 2353 orders afterwards (p<0.001; χ2 test). MAEs occurred in 7.0% of 1473 non-intravenous doses pre-intervention and 4.3% of 1139 afterwards (p = 0.005; χ2 test). Patient identity was not checked for 82.6% of 1344 doses pre-intervention and 18.9% of 1291 afterwards (p<0.001; χ2 test). Medical staff required 15 s to prescribe a regular inpatient drug pre-intervention and 39 s afterwards (p = 0.03; t test). Time spent providing a ward pharmacy service increased from 68 min to 98 min each weekday (p = 0.001; t test); 22% of drug charts were unavailable pre-intervention. Time per drug administration round decreased from 50 min to 40 min (p = 0.006; t test); nursing time on medication tasks outside of drug rounds increased from 21.1% to 28.7% (p = 0.006; χ2 test). Conclusions: A closed-loop electronic prescribing, dispensing and barcode patient identification system reduced prescribing errors and MAEs, and increased confirmation of patient identity before administration. Time spent on medication-related tasks increased.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

The one-dimensional variational assimilation of vertical temperature information in the presence of a boundary-layer capping inversion is studied. For an optimal analysis of the vertical temperature profile, an accurate representation of the background error covariances is essential. The background error covariances are highly flow-dependent due to the variability in the presence, structure and height of the boundary-layer capping inversion. Flow-dependent estimates of the background error covariances are shown by studying the spread in an ensemble of forecasts. A forecast of the temperature profile (used as a background state) may have a significant error in the position of the capping inversion with respect to observations. It is shown that the assimilation of observations may weaken the inversion structure in the analysis if only magnitude errors are accounted for as is the case for traditional data assimilation methods used for operational weather prediction. The positional error is treated explicitly here in a new data assimilation scheme to reduce positional error, in addition to the traditional framework to reduce magnitude error. The distribution of the positional error of the background inversion is estimated for use with the new scheme.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

Two errors in my paper “Wave functions for the methane molecule” [1] are corrected. They concern my f-harmonic approximation to the wave-function in the equilibrium configuration, for which the final expression for the wave function, the energy lowering, and the density function were all in error.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

The article considers screening human populations with two screening tests. If any of the two tests is positive, then full evaluation of the disease status is undertaken; however, if both diagnostic tests are negative, then disease status remains unknown. This procedure leads to a data constellation in which, for each disease status, the 2 × 2 table associated with the two diagnostic tests used in screening has exactly one empty, unknown cell. To estimate the unobserved cell counts, previous approaches assume independence of the two diagnostic tests and use specific models, including the special mixture model of Walter or unconstrained capture–recapture estimates. Often, as is also demonstrated in this article by means of a simple test, the independence of the two screening tests is not supported by the data. Two new estimators are suggested that allow associations of the screening test, although the form of association must be assumed to be homogeneous over disease status. These estimators are modifications of the simple capture–recapture estimator and easy to construct. The estimators are investigated for several screening studies with fully evaluated disease status in which the superior behavior of the new estimators compared to the previous conventional ones can be shown. Finally, the performance of the new estimators is compared with maximum likelihood estimators, which are more difficult to obtain in these models. The results indicate the loss of efficiency as minor.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

The paper considers meta-analysis of diagnostic studies that use a continuous score for classification of study participants into healthy or diseased groups. Classification is often done on the basis of a threshold or cut-off value, which might vary between studies. Consequently, conventional meta-analysis methodology focusing solely on separate analysis of sensitivity and specificity might be confounded by a potentially unknown variation of the cut-off value. To cope with this phenomena it is suggested to use, instead, an overall estimate of the misclassification error previously suggested and used as Youden’s index and; furthermore, it is argued that this index is less prone to between-study variation of cut-off values. A simple Mantel–Haenszel estimator as a summary measure of the overall misclassification error is suggested, which adjusts for a potential study effect. The measure of the misclassification error based on Youden’s index is advantageous in that it easily allows an extension to a likelihood approach, which is then able to cope with unobserved heterogeneity via a nonparametric mixture model. All methods are illustrated at hand of an example on a diagnostic meta-analysis on duplex doppler ultrasound, with angiography as the standard for stroke prevention.