Patient safety--who cares?

Medical errors and adverse events are a serious threat to patients worldwide. In recent years methodologically sound studies have demonstrated that interventions exist, can be implemented and can have sustainable, measurable positive effects on patient safety. Nonetheless, system-wide progress and adoption of safety practices is slow and evidence of improvements on the organisational and systems level is scarce and ambiguous. This paper reports on the Swiss Patient Safety Conference in 2011 and addresses emerging issues for patient safety and future challenges.

[Patients as vigilant partners - patient involvement in patient safety]

Patients can contribute to the improvement in patient safety. They are usually vigilant observers of the care they receive and can provide information about adverse events and safety-related processes. In addition, they can help to prevent errors by active engagement in safety. This potential for involvement in error prevention is increasingly acknowledged internationally. Educational material has been developed and can be used to instruct and motivate patients to monitor care for failures and errors and communicate their observations towards health care workers. Preliminary research suggests that this approach can be successful in improving patient safety.

[Second victim : Critical incident stress management in clinical medicine]

BACKGROUND Critical incidents in clinical medicine can have far-reaching consequences on patient health. In cases of severe medical errors they can seriously harm the patient or even lead to death. The involvement in such an event can result in a stress reaction, a so-called acute posttraumatic stress disorder in the healthcare provider, the so-called second victim of an adverse event. Psychological distress may not only have a long lasting impact on quality of life of the physician or caregiver involved but it may also affect the ability to provide safe patient care in the aftermath of adverse events. METHODS A literature review was performed to obtain information on care giver responses to medical errors and to determine possible supportive strategies to mitigate negative consequences of an adverse event on the second victim. An internet search and a search in Medline/Pubmed for scientific studies were conducted using the key words "second victim, "medical error", "critical incident stress management" (CISM) and "critical incident stress reporting system" (CIRS). Sources from academic medical societies and public institutions which offer crisis management programs where analyzed. The data were sorted by main categories and relevance for hospitals. Analysis was carried out using descriptive measures. RESULTS In disaster medicine and aviation navigation services the implementation of a CISM program is an efficient intervention to help staff to recover after a traumatic event and to return to normal functioning and behavior. Several other concepts for a clinical crisis management plan were identified. CONCLUSIONS The integration of CISM and CISM-related programs in a clinical setting may provide efficient support in an acute crisis and may help the caregiver to deal effectively with future error events and employee safety.

Finite element analysis for prediction of bone strength

Article preview View full access options BoneKEy Reports | Review Print Email Share/bookmark Finite element analysis for prediction of bone strength Philippe K Zysset, Enrico Dall'Ara, Peter Varga & Dieter H Pahr Affiliations Corresponding author BoneKEy Reports (2013) 2, Article number: 386 (2013) doi:10.1038/bonekey.2013.120 Received 03 January 2013 Accepted 25 June 2013 Published online 07 August 2013 Article tools Citation Reprints Rights & permissions Abstract Abstract• References• Author information Finite element (FE) analysis has been applied for the past 40 years to simulate the mechanical behavior of bone. Although several validation studies have been performed on specific anatomical sites and load cases, this study aims to review the predictability of human bone strength at the three major osteoporotic fracture sites quantified in recently completed in vitro studies at our former institute. Specifically, the performance of FE analysis based on clinical computer tomography (QCT) is compared with the ones of the current densitometric standards, bone mineral content, bone mineral density (BMD) and areal BMD (aBMD). Clinical fractures were produced in monotonic axial compression of the distal radii, vertebral sections and in side loading of the proximal femora. QCT-based FE models of the three bones were developed to simulate as closely as possible the boundary conditions of each experiment. For all sites, the FE methodology exhibited the lowest errors and the highest correlations in predicting the experimental bone strength. Likely due to the improved CT image resolution, the quality of the FE prediction in the peripheral skeleton using high-resolution peripheral CT was superior to that in the axial skeleton with whole-body QCT. Because of its projective and scalar nature, the performance of aBMD in predicting bone strength depended on loading mode and was significantly inferior to FE in axial compression of radial or vertebral sections but not significantly inferior to FE in side loading of the femur. Considering the cumulated evidence from the published validation studies, it is concluded that FE models provide the most reliable surrogates of bone strength at any of the three fracture sites.

Ecological validity of virtual reality daily living activities screening for early dementia: longitudinal study

Background: Dementia is a multifaceted disorder that impairs cognitive functions, such as memory, language, and executive functions necessary to plan, organize, and prioritize tasks required for goal-directed behaviors. In most cases, individuals with dementia experience difficulties interacting with physical and social environments. The purpose of this study was to establish ecological validity and initial construct validity of a fire evacuation Virtual Reality Day-Out Task (VR-DOT) environment based on performance profiles as a screening tool for early dementia. Objective: The objectives were (1) to examine the relationships among the performances of 3 groups of participants in the VR-DOT and traditional neuropsychological tests employed to assess executive functions, and (2) to compare the performance of participants with mild Alzheimer’s-type dementia (AD) to those with amnestic single-domain mild cognitive impairment (MCI) and healthy controls in the VR-DOT and traditional neuropsychological tests used to assess executive functions. We hypothesized that the 2 cognitively impaired groups would have distinct performance profiles and show significantly impaired independent functioning in ADL compared to the healthy controls. Methods: The study population included 3 groups: 72 healthy control elderly participants, 65 amnestic MCI participants, and 68 mild AD participants. A natural user interface framework based on a fire evacuation VR-DOT environment was used for assessing physical and cognitive abilities of seniors over 3 years. VR-DOT focuses on the subtle errors and patterns in performing everyday activities and has the advantage of not depending on a subjective rating of an individual person. We further assessed functional capacity by both neuropsychological tests (including measures of attention, memory, working memory, executive functions, language, and depression). We also evaluated performance in finger tapping, grip strength, stride length, gait speed, and chair stands separately and while performing VR-DOTs in order to correlate performance in these measures with VR-DOTs because performance while navigating a virtual environment is a valid and reliable indicator of cognitive decline in elderly persons. Results: The mild AD group was more impaired than the amnestic MCI group, and both were more impaired than healthy controls. The novel VR-DOT functional index correlated strongly with standard cognitive and functional measurements, such as mini-mental state examination (MMSE; rho=0.26, P=.01) and Bristol Activities of Daily Living (ADL) scale scores (rho=0.32, P=.001). Conclusions: Functional impairment is a defining characteristic of predementia and is partly dependent on the degree of cognitive impairment. The novel virtual reality measures of functional ability seem more sensitive to functional impairment than qualitative measures in predementia, thus accurately differentiating from healthy controls. We conclude that VR-DOT is an effective tool for discriminating predementia and mild AD from controls by detecting differences in terms of errors, omissions, and perseverations while measuring ADL functional ability.

Universally Applicable Model for the Quantitative Determination of Lake Sediment Composition Using Fourier Transform Infrared Spectroscopy

ABSTRACT: Fourier transform infrared spectroscopy (FTIRS) can provide detailed information on organic and minerogenic constituents of sediment records. Based on a large number of sediment samples of varying age (0�340 000 yrs) and from very diverse lake settings in Antarctica, Argentina, Canada, Macedonia/Albania, Siberia, and Sweden, we have developed universally applicable calibration models for the quantitative determination of biogenic silica (BSi; n = 816), total inorganic carbon (TIC; n = 879), and total organic carbon (TOC; n = 3164) using FTIRS. These models are based on the differential absorbance of infrared radiation at specific wavelengths with varying concentrations of individual parameters, due to molecular vibrations associated with each parameter. The calibration models have low prediction errors and the predicted values are highly correlated with conventionally measured values (R = 0.94�0.99). Robustness tests indicate the accuracy of the newly developed FTIRS calibration models is similar to that of conventional geochemical analyses. Consequently FTIRS offers a useful and rapid alternative to conventional analyses for the quantitative determination of BSi, TIC, and TOC. The rapidity, cost-effectiveness, and small sample size required enables FTIRS determination of geochemical properties to be undertaken at higher resolutions than would otherwise be possible with the same resource allocation, thus providing crucial sedimentological information for climatic and environmental reconstructions.

Traktaty pedagogiczne Honoraty z Wiśniowskich Zapovej i Klementyny z Tańskich Hoffmanowej – inspiracja czy przeróbka?

As is well know, the long-lasting influence in Poland of Hoffmanowa’s conservative pedagogical treatise « Keepsake of a Good Mother » (1819) was criticized by more progressive Polish women writers of the 19th century, such as Narcyza Żmichowska and Eliza Orzeszkowa. But the unexpected success of that book in other Slav countries later in the 19th century, especially in Bohemia, is less well known. Honorata z Wiśniowskich Zapová (1825-1856), a member of the Galician Polish szlachta who moved to Prague after her marriage in 1841 to the Czech writer K. V. Zap, has been recently exhumed as a Czech writer by Czech and Polish literary criticism: apart from her essays in Czech journals on her native country, much emphasis has been laid on the value of her most important work, Nezabudky, dar našim pannám (Forget-me-not: A Gift to Our Young Ladies, published in 1859), which was the first book of pedagogy dedicated to the instruction of young women in Bohemia. In her preface to this book, Zapová mentions Hoffmanowa as being one of her many sources of inspiration. Wishing to know more about what exactly Zapová owes to Hoffmanowa, in this article I compare Hoffmanowa’s book of pedagogy with Zapová’s. I am astonished to discover that Zapová’s book is in fact an almost literal translation from Polish to Czech of „Keepsake of a Good Mother” – in other words, that it is a plagiarism of Hoffmanowa’s book. The main question I ask here is : why did no one until now, either in 19th-century criticism or in our contemporary criticism, mention this literary fraud before?

Silence That Can Be Dangerous: A Vignette Study to Assess Healthcare Professionals' Likelihood of Speaking up about Safety Concerns

PURPOSE To investigate the likelihood of speaking up about patient safety in oncology and to clarify the effect of clinical and situational context factors on the likelihood of voicing concerns. PATIENTS AND METHODS 1013 nurses and doctors in oncology rated four clinical vignettes describing coworkers' errors and rule violations in a self-administered factorial survey (65% response rate). Multiple regression analysis was used to model the likelihood of speaking up as outcome of vignette attributes, responder's evaluations of the situation and personal characteristics. RESULTS Respondents reported a high likelihood of speaking up about patient safety but the variation between and within types of errors and rule violations was substantial. Staff without managerial function provided significantly higher levels of decision difficulty and discomfort to speak up. Based on the information presented in the vignettes, 74%-96% would speak up towards a supervisor failing to check a prescription, 45%-81% would point a coworker to a missed hand disinfection, 82%-94% would speak up towards nurses who violate a safety rule in medication preparation, and 59%-92% would question a doctor violating a safety rule in lumbar puncture. Several vignette attributes predicted the likelihood of speaking up. Perceived potential harm, anticipated discomfort, and decision difficulty were significant predictors of the likelihood of speaking up. CONCLUSIONS Clinicians' willingness to speak up about patient safety is considerably affected by contextual factors. Physicians and nurses without managerial function report substantial discomfort with speaking up. Oncology departments should provide staff with clear guidance and trainings on when and how to voice safety concerns.

Key points for patient safety in dialysis access.

For more than 15 years, patient safety has been an issue in different domains of medicine. There is evidence for this subject and also a great need for information. First, we should be familiar with the basic terminology such as the relationship between adverse events and errors, and understand the variations of error. In patient management, besides skills and knowledge (evidence-based medicine), the ability (competence) of healthcare professionals to act and react in unexpected situations is key to prevent and treat adverse events. Not only healthcare professionals should be involved in the process but also healthy people in a way that they understand and patients in a way that they are actively involved. This paper will show how a more general view of patient safety can and should be implemented in the daily work of caregivers dealing with dialysis access in different aspects. A key factor to advance in this subject is to be open-minded and sensualized for this topic. The reader should get an idea of how an institution can create a culture of safety.

A Passive WiFi Source Localization System based on Fine-grained Power-based Trilateration

Indoor localization systems become more interesting for researchers because of the attractiveness of business cases in various application fields. A WiFi-based passive localization system can provide user location information to third-party providers of positioning services. However, indoor localization techniques are prone to multipath and Non-Line Of Sight (NLOS) propagation, which lead to significant performance degradation. To overcome these problems, we provide a passive localization system for WiFi targets with several improved algorithms for localization. Through Software Defined Radio (SDR) techniques, we extract Channel Impulse Response (CIR) information at the physical layer. CIR is later adopted to mitigate the multipath fading problem. We propose to use a Nonlinear Regression (NLR) method to relate the filtered power information to propagation distances, which significantly improves the ranging accuracy compared to the commonly used log-distance path loss model. To mitigate the influence of ranging errors, a new trilateration algorithm is designed as well by combining Weighted Centroid and Constrained Weighted Least Square (WC-CWLS) algorithms. Experiment results show that our algorithm is robust against ranging errors and outperforms the linear least square algorithm and weighted centroid algorithm.

Great expectations: what can fMRI research tell us about psychological phenomena?

Expectations for what functional magnetic resonance imaging (fMRI) can offer psychophysiology vary greatly. Overreaching enthusiasm such as the idea that fMRI can reveal lies and political attitudes are as common as the opinion that fMRI, in its current form, is useless for the advancement of psychological theories. Errors in the inferences being drawn from fMRI data may be contributing to each of these extreme positions, so the present paper addresses these several common inferential errors and describes some of the potential of fMRI for psychophysiological theory and research.

GRAIL gravity field determination using the Celestial Mechanics Approach

The NASA mission GRAIL (Gravity Recovery and Interior Laboratory) inherited its concept from the GRACE (Gravity Recovery and Climate Experiment) mission to determine the gravity field of the Moon. We present lunar gravity fields based on the data of GRAIL’s primary mission phase. Gravity field recovery is realized in the framework of the Celestial Mechanics Approach, using a development version of the Bernese GNSS Software along with Ka-band range-rate data series as observations and the GNI1B positions provided by NASA JPL as pseudo-observations. By comparing our results with the official level-2 GRAIL gravity field models we show that the lunar gravity field can be recovered with a high quality by adapting the Celestial Mechanics Approach, even when using pre-GRAIL gravity field models as a priori fields and when replacing sophisticated models of non-gravitational accelerations by appropriately spaced pseudo-stochastic pulses (i.e., instantaneous velocity changes). We present and evaluate two lunar gravity field solutions up to degree and order 200 – AIUB-GRL200A and AIUB-GRL200B. While the first solution uses no gravity field information beyond degree 200, the second is obtained by using the official GRAIL field GRGM900C up to degree and order 660 as a priori information. This reduces the omission errors and demonstrates the potential quality of our solution if we resolved the gravity field to higher degree.

Patientensicherheit in der Shuntchirurgie

Zusammenfassung Hintergrund. Hämodialysepatienten, die operativ mit einem Gefäßzugang versorgt werden müssen, sind eine vulnerable Patientengruppe, die aufgrund von Multimorbidität, der intensiven und oft fragmentierten Behandlung und vieler Schnittstellen ein erhöhtes Risiko für vermeidbare unerwünschte Ereignisse tragen. Fragestellung. Aktuelle Entwicklungen und Maßnahmen zur Förderung der Patientensicherheit mit Fokus auf die Shuntchirurgie. Material und Methoden. Auswertung und Aufarbeitung aktueller Daten zur Patientensicherheit und Instrumenten zu ihrer Förderung. Ergebnisse. Fehler im nicht operativen Management verursachen einen wesentlichen Anteil der unerwünschten Ereignisse. Checklisten, präoperative Seitenmarkierung, Zählkontrollen und interprofessionelle Teamtrainings sind wichtige Instrumente der Patientensicherheit im OP. Standardisierungen von postoperativen Übergaben durch einfache Protokolle können erheblich zur Reduktion von Fehlern und Schädigungen beitragen. Die Sicherheitskultur einer Abteilung ist ein Umgebungsfaktor, der für die Effektivität dieser Sicherheitsbarrieren wesentlich ist. Schlussfolgerungen. Es existieren wirksame Instrumente, die die Patientensicherheit in der Shuntchirurgie fördern. Gerade an den Schnittstellen zur weiteren Versorgung können durch die konsequente Implementierung und Nutzung dieser Maßnahmen und ein aktives Sicherheitsmanagement unerwünschte Ereignisse vermieden werden. Die interprofessionelle und interdisziplinäre Zusammenarbeit und der Einbezug der Patienten sind wichtige Ressource für die Behandlungssicherheit, die stärker genutzt werden sollten.

NetCodCCN: a Network Coding approach for Content-Centric Networks

Content-Centric Networking (CCN) naturally supports multi-path communication, as it allows the simultaneous use of multiple interfaces (e.g. LTE and WiFi). When multiple sources and multiple clients are considered, the optimal set of distribution trees should be determined in order to optimally use all the available interfaces. This is not a trivial task, as it is a computationally intense procedure that should be done centrally. The need for central coordination can be removed by employing network coding, which also offers improved resiliency to errors and large throughput gains. In this paper, we propose NetCodCCN, a protocol for integrating network coding in CCN. In comparison to previous works proposing to enable network coding in CCN, NetCodCCN permit Interest aggregation and Interest pipelining, which reduce the data retrieval times. The experimental evaluation shows that the proposed protocol leads to significant improvements in terms of content retrieval delay compared to the original CCN. Our results demonstrate that the use of network coding adds robustness to losses and permits to exploit more efficiently the available network resources. The performance gains are verified for content retrieval in various network scenarios.

Structural brain correlates of defective gesture performance in schizophrenia

INTRODUCTION The neural correlates of impaired performance of gestures are currently unclear. Lesion studies showed variable involvement of the ventro-dorsal stream particularly left inferior frontal gyrus (IFG) in gesture performance on command. However, findings cannot be easily generalized as lesions may be biased by the architecture of vascular supply and involve brain areas beyond the critical region. The neuropsychiatric syndrome of schizophrenia shares apraxic-like errors and altered brain structure without macroanatomic lesions. Schizophrenia may therefore qualify as a model disorder to test neural correlates of gesture impairments. METHODS We included 45 schizophrenia patients and 44 healthy controls in the study to investigate the structural brain correlates of defective gesturing in schizophrenia using voxel based morphometry. Gestures were tested in two domains: meaningful gestures (transitive and intransitive) on verbal command and imitation of meaningless gestures. Cut-off scores were used to separate patients with deficits, patients without deficits and controls. Group differences in gray matter (GM) volume were explored in an ANCOVA. RESULTS Patients performed poorer than controls in each gesture category (p < .001). Patients with deficits in producing meaningful gestures on command had reduced GM predominantly in left IFG, with additional involvement of right insula and anterior cingulate cortex. Patients with deficits differed from patients without deficits in right insula, inferior parietal lobe (IPL) and superior temporal gyrus. CONCLUSIONS Impaired performance of meaningful gestures on command was linked to volume loss predominantly in the praxis network in schizophrenia. Thus, the behavioral similarities between apraxia and schizophrenia are paralleled by structural alterations. However, few associations between behavioral impairment and structural brain alterations appear specific to schizophrenia.