Improving disclosure of medical errors: Including patients and family members in the disclosure process

Over the last decade, adverse events and medical errors have become a main focus of interest for the standards of quality and safety in the U.S. healthcare system (Weinstein & Henderson, 2009). Particularly when a medical error occurs, the disclosure of medical errors and its practices have become a focal point of the healthcare process. Patients and family members who have experienced a medical error might be able to provide knowledge and insight on how to improve the disclose process. However, patient and family member are not typically involved in the disclosure process, thus their experiences go unnoticed. ^ The purpose of this research was to explore how best to include patients and family members in the disclosure process regarding a medical error. The research consisted of 28 qualitative interviews from three stakeholder groups: Hospital Administrators, Clinical Service Providers, and Patients and Family Members. They were asked for their ideas and suggestions on how best to include patients and family members in the disclosure process. Framework Analysis was used to analyze this data and find prevalent themes based on the primary research question. A secondary aim was to index categories created based on the interviews that were collected. Data was used from the Texas Disclosure and Compensation Study with Dr. Eric Thomas as the Principal Investigator. Full acknowledgement of access to this data is given to Dr. Thomas. ^ The themes from the research revealed that each stakeholder group was interested and open to including patients and family members in the disclosure process and that the disclosure process should not be a "one-way" avenue. The themes gave many suggestions regarding how to best include patients and family members in the disclosure process of a medical error. Secondary aims revealed several ways to assess the ideas and suggestion given by the stakeholders. Overall, acceptability of getting the perspective of patients and family members was the most common theme. Comparison of each stakeholder group revealed that including patients and family members would be beneficial to improving hospital disclosure practices. ^ Conclusions included a list of recommendations and measureable appropriate strategies that could provide hospital with key stakeholders insights on how to improve their disclosure process. Sharing patients and family members experience with healthcare providers can encourage a shift in culture where patients are valued and active in participating in hospital practices. To my knowledge, this research is the very first of its kind and moves the disclosure process conversation forward in a patient-family member inclusion direction that will assist in improving disclosure practices. Future research should implement and evaluate the success of the various inclusion strategies.^

Mesocosm experiment Cape Verde 2012: Setup

Two 7-day mesocosm experiments were conducted in October 2012 at the Instituto Nacional de Desenvolvimento das Pescas (INDP), Mindelo, Cape Verde. Surface water was collected at night before the start of the respective experiment with RV Islândia south of São Vicente (16°44.4'N, 25°09.4'W) and transported to shore using four 600L food safe intermediate bulk containers. Sixteen mesocosm bags were distributed in four flow-through water baths and shaded with blue, transparent lids to approximately 20% of surface irradiation. Mesocosm bags were filled from the containers by gravity, using a submerged hose to minimize bubbles. The accurate volume inside the individual bags was calculated after addition of 1.5 mmol silicate and measuring the resulting silicate concentration. The volume ranged from 105.5 to 145 L. The experimental manipulation comprised addition of different amounts of inorganic N and P. In the first experiment, the P supply was changed at constant N supply in thirteen of the sixteen units, while in the second experiment the N supply was changed at constant P supply in twelve of the sixteen units. In addition to this, "cornerpoints" were chosen that were repeated during both experiments. Four cornerpoints should have been repeated, but setting the nutrient levels in one mesocosm was not succesfull and therefore this mesocosm also was set at the center point conditions. Experimental treatments were evenly distributed between the four water baths. Initial sampling of the mesocosms on day 1 of each run was conducted between 9:45 and 11:30. After nutrient manipulation, sampling was conducted on a daily basis between 09:00 and 10:30 for days 2 to 8.

Shipborne ocean color remote sensing

In this paper, modernized shipborne procedures are presented to collect and process above-water radiometry for remote sensing applications. A setup of five radiometers and a bidirectional camera system, which provides panoramic sea surface and sky images, is proposed for the collection of high-resolution radiometric quantities. Images from the camera system can be used to determine sky state and potential glint, whitecaps, or foam contamination. A peak in the observed remote sensing reflectance RRS spectra between 750-780 nm was typically found in spectra with relatively high surface reflected glint (SRG), which suggests this waveband could be a useful SRG indicator. Simplified steps for computing uncertainties in SRG corrected RRS are proposed and discussed. The potential of utilizing "unweighted multimodel averaging," which is the average of four or more common SRG correction models, is examined to determine the best approximation RRS. This best approximation RRS provides an estimate of RRS based on various SRG correction models established using radiative transfer simulations and field investigations. Applying the average RRS provides a measure of the inherent uncertainties or biases that result from a user subjectively choosing any one SRG correction model. Comparisons between inherent and apparent optical property derived observations were used to assess the robustness of the SRG multimodel averaging ap- proach. Correlations among the standard SRG models were completed to determine the degree of association or similarities between the SRG models. Results suggest that the choice of glint models strongly affects derived RRS values and can also influence the blue to green band ratios used for modeling biogeochemical parameters such as for chlorophyll a. The objective here is to present a uniform and traceable methodology for determining ship- borne RRS measurements and its associated errors due to glint correction and to ensure the direct comparability of these measurements in future investigations. We encourage the ocean color community to publish radiometric field measurements with matching and complete metadata in open access repositories.