Patient Safety Net Update

It’s been three months since we’ve gone live with Patient Safety Net, and it has been a great success! Managers and front line staff have been trained on how to input, review, and submit event reports that formerly were detailed on the hard copy “RIR” forms. Utilization of the webbased PSN system has been better than expected. PSN has enabled us to greatly improve the way we document and react to patient safety related events.

Patient Safety Alert : A new way to share patient safety information among departments and units

Communication : If there is one topic that comes up over and over again as we discuss ways to make John Dempsey Hospital the safest hospital, it is “communication.” In fact, several of the 2006 and 2007 National Patient Safety Goals are centered around improving the effectiveness of communication among caregivers. There are many ways of doing this, and we have implemented several already. These include handoffs, medication reconciliation, “SBAR,” etc. On page two, we will talk in more detail about hand-offs and the use of “SBAR.”

A qualitative analysis of leadership styles and the selection of quality improvement in primary care practice

In the Practice Change Model, physicians act as key stakeholders, people who have both an investment in the practice and the capacity to influence how the practice performs. This leadership role is critical to the development and change of the practice. Leadership roles and effectiveness are an important factor in quality improvement in primary care practices.^ The study conducted involved a comparative case study analysis to identify leadership roles and the relationship between leadership roles and the number and type of quality improvement strategies adopted during a Practice Change Model-based intervention study. The research utilized secondary data from four primary care practices with various leadership styles. The practices are located in the San Antonio region and serve a large Hispanic population. The data was collected by two ABC Project Facilitators from each practice during a 12-month period including Key Informant Interviews (all staff members), MAP (Multi-method Assessment Process), and Practice Facilitation field notes. This data was used to evaluate leadership styles, management within the practice, and intervention tools that were implemented. The chief steps will be (1) to analyze if the leader-member relations contribute to the type of quality improvement strategy or strategies selected (2) to investigate if leader-position power contributes to the number of strategies selected and the type of strategy selected (3) and to explore whether the task structure varies across the four primary care practices.^ The research found that involving more members of the clinic staff in decision-making, building bridges between organizational staff and clinical staff, and task structure are all associated with the direct influence on the number and type of quality improvement strategies implemented in primary care practice.^ Although this research only investigated leadership styles of four different practices, it will offer future guidance on how to establish the priorities and implementation of quality improvement strategies that will have the greatest impact on patient care improvement. ^

Doctor-patient communication in the medical interaction: Context, implications, and practice

Effective communication; whether from an interpersonal, mass media, or global perspective, is a critical component in public health. It is an essential conduit in increasing public awareness of available health resources, potential health hazards and related disease prevention strategies, and in delivering better health care. Within this context, available literature asserts doctor-patient communication as central to healthcare delivery. It has been shown to affect patient health outcomes, satisfaction with care, adherence to treatment recommendations, and even understanding of medical information. While research supports the essential imperative of interventions aimed at teaching doctors and patients the communication skills necessary for a successful and meaningful medical interaction, most interventions to date, focus on teaching these communication skills to doctors and seem to rely, largely, on mass media for providing patients with the information needed to increase communication efficacy. This study sought to fill a significant gap in the doctor-patient communication literature by reviewing the context of the doctor-patient exchange in the medical interaction, the implications of this exchange in resulting care of the patient, and the potential improvements to practice through interventions aimed at improving the communication exchange. Closing with an evaluation of a patient-centered communication intervention, the “How to Talk to Your Doctor” (HTTTYD) program that combines previously identified optimal strategies for improving communication between doctors and patients, this study examined the patients’ perspective of their potential as better communicators in the medical interaction. ^ Specific Aims, Hypotheses or Questions (Aim I) To examine the context of health communication within a public health framework and its relation to health care delivery. (Aim II) To review doctor-patient communication as a central focus within health care delivery and the resulting implications to patient care. (Aim III) To assess the utility of interventions to improve doctor-patient communication. Specifically, to evaluate the effectiveness of a patient-centered community education intervention, the “How to Talk to Your Doctor” (HTTTYD) program, aimed at improving patient communication efficacy.^

Cross-culture perspectives on fear of HIV disease and AIDS in health care workers

Health care workers have been known to carry into the workplace a variety of judgmental and negative attitudes towards their patients. In no other area of patient care has this issue been more pronounced as in the management of patients with AIDS. Health care workers have refused to treat or manage patients with AIDS and have often treated them more harshly than identically described leukemia patients. Some health care institutions have simply refused to admit patients with AIDS and even recent applicants to medical colleges and schools of nursing have indicated a preference for schools in areas with low prevalence of HIV disease. Since the attitudes of health care workers do have significant consequences on patient management, this study was carried out to determine the differences in clinical practice in Nigeria and the United States of America as it relates to knowledge of a patient's HIV status, determine HIV prevalence and culture in each of the study sites and how they impact on infection control practices, determine the relationship between infection control practices and fear of AIDS, and also determine the predictors of safe infection control practices in each of the study sites.^ The study utilized the 38-item fear of AIDS scale and the measure of infection control questionnaire for its data. Questionnaires were administered to health care workers at the university teaching hospital sites of Houston, Texas and Calabar in Nigeria. Data was analyzed using a chi-square test, and where appropriate, a student t-tests to establish the demographic variables for each country. Factor analysis was done using principal components analysis followed by varimax rotation to simple structure. The subscale scores for each study site were compared using t-tests (separate variance estimates) and utilizing Bonferroni adjustments for number of tests. Finally, correlations were carried out between infection control procedures and fear of AIDS in each study site using Pearson-product moment correlation coefficients.^ The study revealed that there were five dimensions of the fear of AIDS in health care workers, namely fear of loss of control, fear of sex, fear of HIV infection through blood and illness, fear of death and medical interventions and fear of contact with out-groups. Fear of loss of control was the primary area of concern in the Nigerian health care workers whereas fear of HIV infection through blood and illness was the most important area of AIDS related feats in United States health care workers. The study also revealed that infection control precautions and practices in Nigeria were based more on normative and social pressures whereas it was based on knowledge of disease transmission, supervision and employee discipline in the United States, and thus stresses the need for focused educational programs in health care settings that emphasize universal precautions at all times and that are sensitive to the cultural nuances of that particular environment. ^

MEDICINE MAN IN TEXAS

The author George (Georgia?) Plunkett Red was the wife of Samuel Clark Red (1861-1940). Dr. Red was the son of Texas pioneer physician Dr. George Clark Red. Dr. Samuel Clark Red was “the county physician of Harris County, one of the organizers of the Harris County Medical Society, a fellow of the American College of Surgeons, and president of the Texas Medical Association.” Not much is known about the author, but given her husband’s position and family history, it can be surmised that she was interested in history and had access to some of the children of other pioneer medical families. There is a brief bibliography for each of the chapters. Part Two of the book consists of biographies of physicians from Texas Counties. Merle Weir, "RED, SAMUEL CLARK," Handbook of Texas Online (http://www.tshaonline.org/handbook/online/articles/fre09), accessed December 10, 2012. Published by the Texas State Historical Association.

Réstif de la Bretonne. La transición del espacio utópico experimental al espacio reducido

La crítica tradicionalmente ha sido muy severa con Réstif de la Bretonne, a quien ha relegado a un segundo plano durante más de cien años por considerarlo un autor marginal. A principios del siglo XX es rescatado de la oscuridad gracias a las teorías freudianas pero recién en los años sesenta se estudia su obra desde otros puntos de vista. Contribuyendo a esta línea, el presente artículo intenta aportar elementos que permitan devolver a Réstif de la Bretonne el lugar que le corresponde dentro de la historia de la literatura y del pensamiento político. A lo largo del siglo XVIII el espacio adquiere un valor fundamental porque se supone que debe ser conocido y dominado para poseer las leyes del mundo entero. Dentro de este marco la novela utópica de nuestro autor titulada El Descubrimiento Austral. Novela Filosófica, textualiza posturas aparentemente disímiles acerca del espacio que convierten a Réstif en uno de los símbolos del período de transición que representa. Las ideas vertidas en esta novela nos permiten afirmar que Réstif de la Bretonne se adelanta, sin duda, a movimientos del siglo XIX como el Socialismo Utópico, el Romanticismo y el Nacionalismo.

Un mundo rural en transición : La campaña bonaerense según el Primer Censo Nacional de Población de la República Argentina (1869)

La campaña de Buenos Aires había recibido desde fines del siglo XVIII importantes corrientes migratorias interprovinciales que fueron progresivamente desplazadas por las provenientes de Europa. Si bien existen trabajos ;basados en los resultados generales, se ha abordado muy poco el ;estudio de la población a partir de las cédulas censales en sí mismas. Nos proponemos aquí observar la estructura de la población de la campaña bonaerense durante estos primeros tiempos de la inmigración masiva, aplicando una perspectiva comparada entre tres pueblos: San Antonio de Areco en la zona norte, Mercedes en el centro y San Vicente en el sur. Se prestará particular atención a la composición de la población, su origen, las actividades productivas y el proceso de urbanización. Se analizan igualmente las pautas de destino y localización geográfica de los extranjeros en los pueblos rurales, las ocupaciones preferidas y la eventual diversificación de actividades en función de las nacionalidades

Las tierras, los ganados, los trabajadores... Una posible reconstrucción de las estancias reduccionales de la experiencia jesuítica bonaerense, 1740-1752

El presente trabajo propone reconstruir el sistema productivo organizado por los misioneros de la Compañía de Jesús al sur de la jurisdicción colonial de Buenos Aires, entre 1740 y 1752. Si bien los hombres de la Compañía desarrollaron durante el siglo XVIII establecimientos productivos en todas las regiones rioplatenses, la característica de este caso se refiere a que la estancias y chacras que son descriptas tienen una vida activa de 12 años en la frontera, es decir, en territorio indígena ocupado por la reducciones pero con un dominio colonial no consolidado. Los espacios fronterizos no son habitados permanentemente por los españoles y la dominación y control del Estado suelen ser esporádicos. Por tanto, la experiencia misional se transforma en un mecanismo que pretende vigilar y controlar, pero que para existir en un territorio cuyo dominio es detentado por otras sociedades debe negociar con las mismas sus condiciones de existencia. ¿Cómo afectó esta situación a la constitución de ┤chacras' y ┤estancias' productivas? ¿En qué medida estos establecimientos se integraron a la red de establecimientos que la Compañía posee en tierras ┤españolas'? ¿La organización es similar en el ámbito fronterizo y en el ámbito ┤efectivamente' colonizado?

Un mundo rural en transición : La campaña bonaerense según el Primer Censo Nacional de Población de la República Argentina (1869)

La campaña de Buenos Aires había recibido desde fines del siglo XVIII importantes corrientes migratorias interprovinciales que fueron progresivamente desplazadas por las provenientes de Europa. Si bien existen trabajos ;basados en los resultados generales, se ha abordado muy poco el ;estudio de la población a partir de las cédulas censales en sí mismas. Nos proponemos aquí observar la estructura de la población de la campaña bonaerense durante estos primeros tiempos de la inmigración masiva, aplicando una perspectiva comparada entre tres pueblos: San Antonio de Areco en la zona norte, Mercedes en el centro y San Vicente en el sur. Se prestará particular atención a la composición de la población, su origen, las actividades productivas y el proceso de urbanización. Se analizan igualmente las pautas de destino y localización geográfica de los extranjeros en los pueblos rurales, las ocupaciones preferidas y la eventual diversificación de actividades en función de las nacionalidades

Las tierras, los ganados, los trabajadores... Una posible reconstrucción de las estancias reduccionales de la experiencia jesuítica bonaerense, 1740-1752

El presente trabajo propone reconstruir el sistema productivo organizado por los misioneros de la Compañía de Jesús al sur de la jurisdicción colonial de Buenos Aires, entre 1740 y 1752. Si bien los hombres de la Compañía desarrollaron durante el siglo XVIII establecimientos productivos en todas las regiones rioplatenses, la característica de este caso se refiere a que la estancias y chacras que son descriptas tienen una vida activa de 12 años en la frontera, es decir, en territorio indígena ocupado por la reducciones pero con un dominio colonial no consolidado. Los espacios fronterizos no son habitados permanentemente por los españoles y la dominación y control del Estado suelen ser esporádicos. Por tanto, la experiencia misional se transforma en un mecanismo que pretende vigilar y controlar, pero que para existir en un territorio cuyo dominio es detentado por otras sociedades debe negociar con las mismas sus condiciones de existencia. ¿Cómo afectó esta situación a la constitución de ┤chacras' y ┤estancias' productivas? ¿En qué medida estos establecimientos se integraron a la red de establecimientos que la Compañía posee en tierras ┤españolas'? ¿La organización es similar en el ámbito fronterizo y en el ámbito ┤efectivamente' colonizado?