Nurse likelihood to report a pediatric medication error: Examination of the "pre-reporting" period

Each year, hospitalized patients experience 1.5 million preventable injuries from medication errors and hospitals incur an additional $3.5 billion in cost (Aspden, Wolcott, Bootman, & Cronenwatt; (2007). It is believed that error reporting is one way to learn about factors contributing to medication errors. And yet, an estimated 50% of medication errors go unreported. This period of medication error pre-reporting, with few exceptions, is underexplored. The literature focuses on error prevention and management, but lacks a description of the period of introspection and inner struggle over whether to report an error and resulting likelihood to report. Reporting makes a nurse vulnerable to reprimand, legal liability, and even threat to licensure. For some nurses this state may invoke a disparity between a person‘s belief about him or herself as a healer and the undeniable fact of the error.^ This study explored the medication error reporting experience. Its purpose was to inform nurses, educators, organizational leaders, and policy-makers about the medication error pre-reporting period, and to contribute to a framework for further investigation. From a better understanding of factors that contribute to or detract from the likelihood of an individual to report an error, interventions can be identified to help the nurse come to a psychologically healthy resolution and help increase reporting of error in order to learn from error and reduce the possibility of future similar error.^ The research question was: "What factors contribute to a nurse's likelihood to report an error?" The specific aims of the study were to: (1) describe participant nurses' perceptions of medication error reporting; (2) describe participant explanations of the emotional, cognitive, and physical reactions to making a medication error; (3) identify pre-reporting conditions that make it less likely for a nurse to report a medication error; and (4) identify pre-reporting conditions that make it more likely for a nurse to report a medication error.^ A qualitative research study was conducted to explore the medication error experience and in particular the pre-reporting period from the perspective of the nurse. A total of 54 registered nurses from a large private free-standing not-for-profit children's hospital in the southwestern United States participated in group interviews. The results describe the experience of the nurse as well as the physical, emotional, and cognitive responses to the realization of the commission of a medication error. The results also reveal factors that make it more and less likely to report a medication error.^ It is clear from this study that upon realization that he or she has made a medication error, a nurse's foremost concern is for the safety of the patient. Fear was also described by each group of nurses. The nurses described a fear of several things including physician reaction, manager reaction, peer reaction, as well as family reaction and possible lack of trust as a result. Another universal response was the description of a struggle with guilt, shame, imperfection, blaming oneself, and questioning one's competence.^

InGen of creative production in the health sciences: A workbook companion to innovation generation

InGen of Creative Production in the Health Sciences is a compendium of innovative thinking exercises for individuals and groups, derived from an eclectic array of practical guides for professionals in a variety of fields. Segmented into five subcategories across twenty two chapters, the effort seeks to make techniques for increasing innovative problem solving more accessible to a diverse audience of problem solvers. The chapters of Roberta Ness. Innovation Generation (2012, Oxford University Press) provide the themes for each of the chapters in the workbook. It is intended that those who read Ness. Innovation Generation will benefit from practicing the constructs of innovative thinking exemplified in each exercise.^ The methods used to gather data, in this case mostly innovative thinking exercises, included literature reviews of existing innovative thinking tools, classroom materials, and theory-driven exploration of exercises to fill in gaps in extant materials. Specifically, Google.com and Amazon.com searches were conducted using the terms “innovation,” “innovative,” “innovator,” “creative,” “novelty,” “thinking,” together with some variance of “book,” “workbook,” and “exercise.” The results were sorted thematically to show correspondence with the themes in Ness (2012) and compared to suggested best practices of 50 years of scientific research on innovative thinking. Where themes were suggested by Ness (2012) and peer-reviewed research on innovation but unavailable in published innovation thinking workbooks, new exercises were developed. The five type subcategories into which these results were organized are: individual direct, individual indirect, group direct, group indirect and probing question. It is anticipated that the five type subcategories and spectrum of themes will equip problem solvers in a variety of capacities.^

Attitudes of dental students to hand hygiene practices at a dental school

Objectives. The purpose of this study was to elucidate behavioral determinants (prevailing attitudes and beliefs) of hand hygiene practices among undergraduate dental students in a dental school. ^ Methods. Statistical modeling using the Integrative Behavioral Model (IBM) prediction was utilized to develop a questionnaire for evaluating behavioral perceptions of hand hygiene practices by dental school students. Self-report questionnaires were given to second, third and fourth year undergraduate dental students. Models representing two distinct hand hygiene practices, termed "elective in-dental school hand hygiene practice" and "inherent in-dental school hand hygiene practice" were tested using linear regression analysis. ^ Results. 58 responses were received (24.5%); the sample mean age was 26.6 years old and females comprised 51%. In our models, elective in-dental school hand hygiene practice and inherent in-dental school hand hygiene practice, explained 40% and 28%, respectively, of the variance in behavioral intention. Translation of community hand hygiene practice to the dental school setting is the predominant driver of elective hand hygiene practice. Intended elective in-school hand hygiene practice is further significantly predicted by students' self-efficacy. Students' attitudes, peer pressure of other dental students and clinic administrators, and role modeling had minimal effects. Inherent hand hygiene intent was strongly predicted by students' beliefs in the benefits of the activity and, to a lesser extent, role modeling. Inherent and elective community behaviors were insignificant. ^ Conclusions. This study provided significant insights into dental student's hand hygiene behavior and can form the basis for an effective behavioral intervention program designed to improve hand hygiene compliance.^

Effects of a health advocacy program to promote physical activity and nutrition behaviors among adolescents: An evaluation of the Young Leaders for Healthy Change program

Background. This study was designed to evaluate the effects of the Young Leaders for Healthy Change program, an internet-delivered program in the school setting that emphasized health advocacy skills-development, on nutrition and physical activity behaviors among older adolescents (13–18 years). The program consisted of online curricular modules, training modules, social media, peer and parental support, and a community service project. Module content was developed based on Social Cognitive Theory and known determinants of behavior for older adolescents. ^ Methods. Of the 283 students who participated in the fall 2011 YL program, 38 students participated in at least ten of the 12 weeks and were eligible for this study. This study used a single group-only pretest/posttest evaluation design. Participants were 68% female, 58% white/Caucasian, 74% 10th or 11th graders, and 89% mostly A and/or B students. The primary behavioral outcomes for this analysis were participation in 60-minutes of physical activity per day, 20-minutes of vigorous- or moderate- intensity physical activity (MVPA) participation per day, television and computer time, fruit and vegetable (FV) intake, sugar-sweetened beverage intake, and consumption of breakfast, home-cooked meals, and fast food. Other outcomes included knowledge, beliefs, and attitudes related to healthy eating, physical activity, and advocacy skills. ^ Findings. Among the 38 participants, no significant changes in any variables were observed. However, among those who did not previously meet behavioral goals there was an 89% increase in students who participated in more than 20 minutes of MVPA per day and a 58% increase in students who ate home-cooked meals 5–7 days per week. The majority of participants met program goals related to knowledge, beliefs, and attitudes prior to the start of the program. Participants reported either maintaining or improving to the goal at posttest for all items except FV intake knowledge, taste and affordability of healthy foods, interest in teaching others about being healthy, and ease of finding ways to advocate in the community. ^ Conclusions. The results of this evaluation indicated that promoting healthy behaviors requires different strategies than maintaining healthy behaviors among high school students. In the school setting, programs need to target the promotion and maintenance of health behaviors to engage all students who participate in the program as part of a class or club activity. Tailoring the program using screening and modifying strategies to meet the needs of all students may increase the potential reach of the program. The Transtheoretical Model may provide information on how to develop a tailored program. Additional research on how to utilize the constructs of TTM effectively among high school students needs to be conducted. Further evaluation studies should employ a more expansive evaluation to assess the long-term effectiveness of health advocacy programming.^

Something real: A social marketing approach to smoking prevention among Montevideo youth

Uruguay has some of the strictest tobacco-control laws in Latin America. Despite this, youth smoking rates in Uruguay are amongst the highest in South America. Thus, it is important to identify strategies to prevent youth smoking in Uruguay. The current qualitative research study sought to identify intrapersonal and socioenvironmental factors that are associated with smoking among middle school youth in Uruguay. It also sought to develop potential prevention strategies and media messages that would resonate with youth for a social media campaign. The study was grounded in social cognitive theory and the theory of reasoned action/planned behavior, among other behavioral science theories; anthropological perspectives were also considered. To achieve these goals, 29 group and individual structured interviews were conducted in two private middle schools catering to lower and higher SES youth in Montevideo, Uruguay during the summer of 2012. One hundred and three study participants, including students, parents, and teachers, were interviewed. The structured interviews were recorded, transcribed, translated, back translated, coded and analyzed. The study findings show that positive attitudes towards smoking (i.e. to be seen, to increase status, to ensure women's equality, to looking old, and to service as a rite of passage), delinquent behavior (i.e. transgression/deviant behavior), social norms that support smoking (i.e. peer pressure and modeling, group membership/sense of belonging, parental modeling, and family support), easy access and availability to tobacco (i.e. retails stores) were factors associated with youth smoking. Potential protective factors may include parental support, negative attitudes towards smoking, sports/music, and smoke-free environments. Because study participants are accustomed to government-sponsored strong countermarketing graphic imaging, study participants selected even stronger images and messages as the preferred way to receive tobacco prevention messages. Something Real ("Algo Real") was a theme that resonated with the participants and chosen as the name for the proposed campaign. This campaign was designed as a multiple component intervention that included mass, school base, and family based strategies to prevent tobacco use. Some intervention materials specific to these intervention components were developed to target relevant intrapersonal and socioenvironmental factors identified above. These materials will be tested in future pilot studies and larger scale evaluation with this population, outside the scope of this dissertation. ^

Two historical maps from nineteenth-century Palestine, with links to digitized maps in shapefile format

Reconstructing past landscapes from historical maps requires quantifying the accuracy and completeness of these sources. The accuracy and completeness of two historical maps of the same period covering the same area in Israel were examined: the 1:63,360 British Palestine Exploration Fund map (1871-1877) and the 1:100,000 French Levés en Galilée (LG) map (1870). These maps cover the mountainous area of the Galilee (northern Israel), a region with significant natural and topographical diversity, and a long history of human presence. Land-cover features from both maps, as well as the contours drawn on the LG map, were digitized. The overall correspondence between land-cover features shown on both maps was 59% and we found that the geo-referencing method employed (transformation type and source of control points) did not significantly affect these correspondence measures. Both maps show that in the 1870s, 35% of the Galilee was covered by Mediterranean maquis, with less than 8% of the area used for permanent agricultural cropland (e.g., plantations). This article presents how the reliability of the maps was assessed by using two spatial historical sources, and how land-cover classes that were mapped with lower certainty and completeness are identified. Some of the causes that led to observed differences between the maps, including mapping scale, time of year, and the interests of the surveyors, are also identified.

Estudio probabilista del daño por choque según la metodología PEER. Aplicación a un paso superior sísmicamente aislado

En países de sismicidad moderada es habitual el uso de puentes cuyo tablero está unido mediante apoyos elastoméricos y/o deslizantes, tanto a las pilas como a los estribos. La principal vulnerabilidad sísmica de estos puentes está asociada a los choques. Dicha vulnerabilidad puede valorarse estimando la probabilidad de que se produzca un determinado daño en un periodo de tiempo. En este artículo se plantean las líneas actuales para estudiar este problema, y se aplican al estudio de la vulnerabilidad de un paso superior situado en la provincia de Granada, que puede considerarse como sísmicamente aislado. El marco del estudio es la metodología del Pacific Earthquake Engineering Research Center, cuya aplicación se ha adaptado al caso estudiado. En el artículo se describen cada una de las etapas de que consta, aunque se presta especial atención a la identificación y caracterización de los daños susceptibles de producirse. El modelo de la estructura, que debe permitir una adecuada caracterización de los choques, también será presentado en detalle. Dado que el puente es representativo de una gran cantidad de estructuras del inventario construido en España, los resultados son doblemente importantes. Por una parte, sirven de guía para la aplicación de esta metodología a estructuras similares. Y por otra, proporcionan valores de probabilidades que pueden servir de referencia.

Peer Assessment and Self-assessment: Effective Learning Tools in Higher Education.

When used appropriately, self- and peer-assessment are very effective learning tools. In the present work, instructor formative assessment and feedback, self-assessment (SA), and peer-assessment (PA) have been compared. During the first part of a semester, the students followed a continuous formative assessment. Subsequently, they were divided into two subgroups based on similar performances. One subgroup performed SAs, and the other followedPAduring the last part of the course. The performances of the two groups in solving problems were compared. Results suggest that PA is a more effective learning tool than SA, and both are more effective than instructor formative assessment. However, a survey that was conducted at the end of the experiment showed higher student confidence in instructor assessment than in PA. The students recognized the usefulness of acting as peer assessors, but believed that SA helped them more than PA.

Uncertainty in Structural Interpretation : Lessons to be learnt

Peer reviewed

Do pingers cause stress in fish? An experimental tank study with European sardine, Sardina pilchardus (Walbaum, 1792) (Actinopterygii, Clupeidae), exposed to a 70 kHz dolphin pinger

Date of acceptance: 06/12/2014 Acknowledgments The study was funded by the Portuguese Ministry of Science (Fundac¸a˜o para a Cieˆncia e Tecnologia– FCT) through a PhD Grant of SG (SFRH/BD/47931/2008). We would like to thank the captain of the purse-seiner (Jose´ Manuel Saveedra) and his crew for facilitating the capture and transport of live fish. Moreover, we want to thank Ana Marc¸alo for suggestions on the experimental design, Manuel Garci for technical advice on underwater video recordings and James Turner from the company Future Oceans for providing technical details on the 70 kHz dolphin pingers. We would also like to acknowledge the scientific advice of Dr. Jose´ Iglesias and the technical and logistic support for the preparation of the laboratory and the materials for tank experiments by Enrique Martı´nez Gonza´lez, Ricardo Pazo´and other staff at the aquaculture facilities of the Spanish Institute for Oceanography (IEO) and the Marine Sciences Station of Toralla (ECIMAT) in Vigo. Furthermore, we are grateful to Francisco de la Granda Grandoso for his practical assistance during the fish tank experiments and to Juan Santos Blanco for helping with statistical analysis. Finally, we would like to thank Pilar Riobo´ Agula, Amelia Fernandez Villamarin, Jose´ Franco Soler, Jose´ Luis Mun˜oz, Angela Benedetti, Marcos Antonio Lopez Patin˜o and Marta Conde Sieira for scientific advice and practical support with cortisol analysis and Rosana Rodrı´guez for preparing histological samples for us.

Peri-conceptional changes in maternal exposure to sewage sludge chemicals disturbs fetal thyroid gland development in sheep

Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

In utero exposure to cigarette chemicals induces sex-specific disruption of one-carbon metabolism and DNA methylation in the human fetal liver

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Acknowledgements: We thank Ms Margaret Fraser, Ms Samantha Flannigan, and Dr Wing Yee Kwong for their expert assistance. The staff at Grampian NHS Pregnancy Counselling Service were essential for collecting fetuses. We thank Professor Geoffrey Hammond and Dr Marc Simard, University of British Colombia for helpful comments on the manuscript. Supported by grants as follows: Scottish Senior Clinical Fellowship (AJD); Chief Scientist Office (Scottish Executive, CZG/1/109 to PAF, & CZG/4/742 (PAF & PJOS); NHS Grampian Endowments 08/02 (PAF, SB & PJOS); the European Community’s Seventh Framework Programme (FP7/2007-2013) under grant agreement no 212885 (PAF & SMR); the Medical Research Council grants MR/L010011/1 (PAF & PJOS) and MR/K018310/1 (AJD). None of the funding bodies played any role in the design, collection, analysis, and interpretation of data, in the writing of the manuscript, nor in the decision to submit the manuscript for publication

Respiratory microbiota resistance and resilience to pulmonary exacerbation and subsequent antimicrobial intervention

This study was supported by the UK Natural Environment Research Council (NE/H019456/1) to CJvdG, by the Wellcome Trust (WT 098051) to AWW and JP for sequencing costs, and by The Anna Trust (KB2008) to KDB. AWW and The Rowett Institute of Nutrition and Health, University of Aberdeen, receive core funding support from the Scottish Government Rural and Environmental Science and Analysis Service (RESAS). We thank Paul Scott, Richard Rance and the Wellcome Trust Sanger Institute’s sequencing team for generating 16S rRNA gene sequence data.

Non-pharmacological interventions to reduce the risk of diabetes in people with impaired glucose regulation : a systematic review and economic evaluation

Peer reviewed