Effects of an educational patient safety campaign on patients' safety behaviours and adverse events

Rationale, aims and objectives  The study aims to investigate the effects of a patient safety advisory on patients' risk perceptions, perceived behavioural control, performance of safety behaviours and experience of adverse incidents. Method  Quasi-experimental intervention study with non-equivalent group comparison was used. Patients admitted to the surgical department of a Swiss large non-university hospital were included. Patients in the intervention group received a safety advisory at their first clinical encounter. Outcomes were assessed using a questionnaire at discharge. Odds ratios for control versus intervention group were calculated. Regression analysis was used to model the effects of the intervention and safety behaviours on the experience of safety incidents. Results  Two hundred eighteen patients in the control and 202 in the intervention group completed the survey (75 and 77% response rates, respectively). Patients in the intervention group were less likely to feel poorly informed about medical errors (OR = 0.55, P = 0.043). There were 73.1% in the intervention and 84.3% in the control group who underestimated the risk for infection (OR = 0.51, CI 0.31-0.84, P = 0.009). Perceived behavioural control was lower in the control group (meanCon  = 3.2, meanInt  = 3.5, P = 0.010). Performance of safety-related behaviours was unaffected by the intervention. Patients in the intervention group were less likely to experience any safety-related incident or unsafe situation (OR for intervention group = 0.57, CI 0.38-0.87, P = 0.009). There were no differences in concerns for errors during hospitalization. There were 96% of patients (intervention) who would recommend other patients to read the advisory. Conclusions  The results suggest that the safety advisory decreases experiences of adverse events and unsafe situations. It renders awareness and perceived behavioural control without increasing concerns for safety and can thus serve as a useful instrument for communication about safety between health care workers and patients.

Safety climate and its association with office type and team involvement in primary care

OBJECTIVE To assess differences in safety climate perceptions between occupational groups and types of office organization in primary care. METHODS Primary care physicians and nurses working in outpatient offices were surveyed about safety climate. Explorative factor analysis was performed to determine the factorial structure. Differences in mean climate scores between staff groups and types of office were tested. Logistic regression analysis was conducted to determine predictors for a 'favorable' safety climate. RESULTS 630 individuals returned the survey (response rate, 50%). Differences between occupational groups were observed in the means of the 'team-based error prevention'-scale (physician 4.0 vs. nurse 3.8, P < 0.001). Medical centers scored higher compared with single-handed offices and joint practices on the 'team-based error prevention'-scale (4.3 vs. 3.8 vs. 3.9, P < 0.001) but less favorable on the 'rules and risks'-scale (3.5 vs. 3.9 vs. 3.7, P < 0.001). Characteristics on the individual and office level predicted favorable 'team-based error prevention'-scores. Physicians (OR = 0.4, P = 0.01) and less experienced staff (OR 0.52, P = 0.04) were less likely to provide favorable scores. Individuals working at medical centers were more likely to provide positive scores compared with single-handed offices (OR 3.33, P = 0.001). The largest positive effect was associated with at least monthly team meetings (OR 6.2, P < 0.001) and participation in quality circles (OR 4.49, P < 0.001). CONCLUSIONS Results indicate that frequent quality circle participation and team meetings involving all team members are effective ways to strengthen safety climate in terms of team-based strategies and activities in error prevention.

Safety, tolerability, and efficacy of fixed combination therapy with dorzolamide hydrochloride 2% and timolol maleate 0.5% in glaucoma and ocular hypertension.

Glaucoma is a collection of diseases characterized by multifactorial progressive changes leading to visual field loss and optic neuropathy most frequently due to elevated intraocular pressure (IOP). The goal of treatment is the lowering of the IOP to prevent additional optic nerve damage. Treatment usually begins with topical pharmacological agents as monotherapy, progresses to combination therapy with agents from up to 4 different classes of IOP-lowering medications, and then proceeds to laser or incisional surgical modalities for refractory cases. The fixed combination therapy with the carbonic anhydrase inhibitor dorzolamide hydrochloride 2% and the beta blocker timolol maleate 0.5% is now available in a generic formulation for the treatment of patients who have not responded sufficiently to monotherapy with beta adrenergic blockers. In pre- and postmarketing clinical studies, the fixed combination dorzolamide-timolol has been shown to be safe and efficacious, and well tolerated by patients. The fixed combination dorzolamide-timolol is convenient for patients, reduces their dosing regimen with the goal of increasing their compliance, reduces the effects of "washout" when instilling multiple drops, and reduces the preservative burden by reducing the number of drops administered per day.

Scheduling the production of rolling ingots: Industrial context, model, and solution method

We study a real-world scheduling problem arising in the context of a rolling ingots production. First we review the production process and discuss peculiarities that have to be observed when scheduling a given set of production orders on the production facilities. We then show how to model this scheduling problem using prescribed time lags between operations, different kinds of resources, and sequence-dependent changeovers. A branch-and-bound solution procedure is presented in the second part. The basic principle is to relax the resource constraints by assuming infinite resource availability. Resulting resource conflicts are then stepwise resolved by introducing precedence relationships among operations competing for the same resources. The algorithm has been implemented as a beam search heuristic enumerating alternative sets of precedence relationships.

Business as Usual? : An Appraisal of the Implementation of the UNESCO Convention on Cultural Diversity into EU’s Media Law and Policies

Irrespective of the diverse stances taken on the effect of the UNESCO Convention on Cultural Diversity in the external relations context, since its wording is fairly open-ended, it is clear to all observers that the Convention’s impact will largely depend on how it is implemented domestically. The discussion on the national implementation of the Convention, both in the policy and in the academic discourses, is only just emerging. The implementation model of the EU could set an important example for the international community and for the other State Parties that have ratified the UNESCO Convention, as both the EU and its Member States acting individually, have played a critical role in the adoption of the Convention, as well as in the longer process of promoting cultural concerns on the international scene. Against this backdrop, this article analyses the extent to which the EU internal law and policies, in particular in the key area of media, take into account the spirit and the letter of the UNESCO Convention on Cultural Diversity. The article seeks to critically evaluate the present state of affairs and make some recommendations for calibration of future policies.

Business as Usual? : The Implementation of the UNESCO Convention on Cultural Diversity and EU Media Law and Policies

Irrespective of the diverse stances taken on the effect of the UNESCO Convention on Cultural Diversity in the external relations context, since its wording is fairly open-ended, it is clear to all observers that the Convention’s impact will largely depend on how it is implemented domestically. The discussion on the national implementation of the Convention, both in the policy and in the academic discourses, is only just emerging, although six years the Convention’s entry into force have passed. The implementation model of the EU can set an important example for the international community and for the other State Parties that have ratified the UNESCO Convention, as both the EU and its Member States acting individually, have played a critical role in the adoption of the Convention, as well as in the longer process of promoting cultural concerns on the international scene. Against this backdrop, this article analyses the extent to which the EU internal law and policies, in particular in the key area of media, take into account the spirit and the letter of the UNESCO Convention on Cultural Diversity. Next to an assessment of the EU’s implementation of the Convention, the article also offers remarks of normative character – in the sense of what should be done to actually attain the objective of protecting and promoting cultural diversity. The article seeks to critically evaluate the present state of affairs and make some recommendations for calibration of future policies.

Updating Cultural Law and Policy for the Digital Age

The chapter is an enquiry of the possibly failing or changed rationales of cultural protectionism in the digital age. It seeks to identify the adjustments needed, so that cultural policy could still serve its benevolent goals and effectively contribute to sustaining a cultural environment that is diverse and vibrant.

Global Cultural Law and Policy in the Age of Ubiquitous Internet

Digital technologies and the Internet in particular have transformed the ways we create, distribute, use, reuse and consume cultural content; have impacted on the workings of the cultural industries, and more generally on the processes of making, experiencing and remembering culture in local and global spaces. Yet, few of these, often profound, transformations have found reflection in law and institutional design. Cultural policy toolkits, in particular at the international level, are still very much offline/analogue and conceive of culture as static property linked to national sovereignty and state boundaries. The article describes this state of affairs and asks the key question of whether there is a need to reform global cultural law and policy and if yes, what the essential elements of such a reform should be.

The oral Law and its defenders : a review

by a scripturalist

Overview and phylogeny of Mycobacterium tuberculosis complex organisms: Implications for diagnostics and legislation of bovine tuberculosis

Members of the Mycobacterium tuberculosis complex (MTBC) cause a serious disease with similar pathology, tuberculosis; in this review, bovine tuberculosis will be considered as disease caused by any member of the MTBC in bovids. Bovine tuberculosis is responsible for significant economic loss due to costly eradication programs and trade limitations and poses a threat to both endangered and protected species as well as to public health. We here give an overview on all members of the MTBC, focusing on their isolation from different animal hosts. We also review the recent advances made in elucidating the evolutionary and phylogenetic relationships of members of the MTBC. Because the nomenclature of the MTBC is controversial, its members have been considered species, subspecies or ecotypes, this review discusses the possible implications for diagnostics and the legal consequences of naming of new species.