Nursing-related medication errors: A review of factors that facilitate and hinder error reporting, and recommendations for improvement

Medication errors, one of the most frequent types of medical errors, are a common cause of patient harm in hospital systems today. Nurses at the bedside are in a position to encounter many of these errors since they are there at the start of the process (ordering/prescribing) and the end of the process (administration). One of the recommendations from the IOM (Institute of Medicine) report, "To Err is Human," was for organizations to identify and learn from medical errors through event reporting systems. While many organizations have reporting systems in place, research studies report a significant amount of underreporting by nurses. A systematic review of the literature was performed to identify contributing factors related to the reporting and not reporting of medication errors by nurses at the bedside.^ Articles included in the literature review were primary or secondary studies, dated January 1, 2000 – July 2009, related to nursing medication error reporting. All 634 articles were reviewed with an algorithm developed to standardize the review process and help filter out those that did not meet the study criteria. In addition, 142 article bibliographies were reviewed to find additional studies that were not found in the original literature search.^ After reviewing the 634 articles and the additional 108 articles discovered in the bibliography review, 41 articles met the study criteria and were used in the systematic literature review results.^ Fear of punitive reactions to medication errors was a frequent barrier to error reporting. Nurses fear reactions from their leadership, peers, patients and their families, nursing boards, and the media. Anonymous reporting systems and departments/organizations with a strong safety culture in place helped to encourage the reporting of medication errors by nursing staff.^ Many of the studies included in this literature review do not allow results that can be generalized. The majority of them took place in single institutions/organizations with limited sample sizes. Stronger studies with larger sample sizes need to be performed, utilizing data collection methods that have been validated, to determine stronger correlations between safety cultures and nurse error reporting.^

The Choosing Healthy Options of Starches (CHOOS) diet and dietary intake self-monitoring for weight loss among adolescent females

Previous research has shown dietary intake self-monitoring, and culturally tailored weight loss interventions to be effective tools for weight loss. Technology can be used to tailor weight loss interventions to better suit adolescents. There is a lack of research to date on the use of personal digital assistants (PDAs) to self-monitor dietary intake among adolescents. The objective of this study was to determine the difference in dietary intake self-monitoring frequency between using a Personal Digital Assistant (PDA) or paper logs as a diet diary in obese adolescent females; and to describe differences in diet adherence, as well as changes in body size and self-efficacy to resist eating. We hypothesized dietary intake self-monitoring frequency would be greater during PDA use than during paper log use. This study was a randomized crossover trial. Participants recorded their diet for 4 weeks: 2 weeks on a PDA and 2 weeks on paper logs. Thirty-four obese females ages 12-20 were recruited for participation. Thirty were included in analyses. Participants recorded more entries/day while using the paper logs (4.10 entries/day ± 0.63) than while using the PDA (3.01 entries/day ±0.75) (p<0.001). Significantly more meals and snacks were skipped during paper log use (0.81/day ± 0.65) than during PDA use (0.23/day ± 0.22) (p=0.011). Changes in body size (BMI, weight, and waist circumference) and self-efficacy to resist eating did not differ significantly between PDA and paper log use. When compared to paper logs, participants felt the PDA was more convenient (p=0.020), looked forward to using the PDA more (p=0.008), and would rather continue using the PDA than the paper logs (p=0.020). The findings of this study indicate use of a PDA as a dietary intake self-monitoring tool among adolescents would not result in increased dietary intake self-monitoring to aid in weight loss. Use of paper logs would result in greater data returned to clinicians, though use of PDAs would likely get adolescents more excited about adhering to recommendations to record their diet. Future research should look at updated communication devices, such as cell phones and other PDAs with additional features, and the role they can play in increasing dietary intake self-monitoring among adolescents.^

2005 ACIP recommendations effect on newborn hepatitis B vaccination rates and the factors affecting the successful implementation of the recommendations in the US

Background. Hepatitis B virus infection is one of major causes of acute and chronic hepatitis, cirrhosis of the liver, and primary hepatocellular carcinoma. Hepatitis B and its long term consequences are major health problems in the United States. Hepatitis B virus can be vertically transmitted from mother to infant during birth. Hepatitis B vaccination at birth is the most effective measure to prevent the newborn from HBV infection and its consequences, and is part of any robust perinatal hepatitis B prevention program following ACIP recommendations. Universal vaccination of the new born will prevent HBV infection during early childhood and, assuming that children receive the three dosages of the vaccine, it will also prevent adolescent and adult infections. Hepatitis B vaccination is now recommended as part of a comprehensive strategy to eliminate HBV transmission in the United States. ^ Objective. (1)To assess if the hepatitis B vaccination rates of newborn babies have improved after the 2005 ACIP recommendations. (2) To identify factors that affects the implementation of ACIP recommendation for hepatitis B vaccination in newborn babies. These factors will encourage ongoing improvement by identifying successful efforts and pinpointing areas that fall short and need attention. Additional focus areas may be identified to accelerate progress in eliminating perinatal HBV transmission.^ Methods. This review includes information from all pertinent articles, reviews, National immunization survey (NIS) surveys, reports, peer reviewed literature and web sources that were published after 1991.The key words to be used for selecting the articles are: "Perinatal Hepatitis B Prevention program", "Universal Hepatitis B vaccination of newborn babies", "ACIP Recommendations." The data gathered will be supplemented with an analysis of vaccination rates using the National Immunization Survey (NIS) birth dose coverage data.^ Results. The data collected in the NIS of 2009 reveals that the national coverage for birth dose of HepB increased to 60.8% from 50.1% in 2006. The largest increase observed for the birth dose in the past 5 years is from 2008 which increased from 55.3 % to 60.8% in 2009. By state, coverage ranged from 22.8% in Vermont to 80.7% in Michigan. %. Overall, in 2009 the estimated vaccination rates are in higher ranges for most states compared to the estimated vaccination rates in 2006. States vary widely in hepatitis B vaccination rates and in their compliance with the 2005 ACIP recommendation. There are many factors at various stages that might affect the successful implementation of the new ACIP recommendation as revealed in literature review. ^ Conclusions. HBV perinatal transmission can be eliminated, but it requires identifying the gaps and measures taken to increase the current vaccination coverage, ensuring timely administration of post exposure immunoprophylaxis and continued evaluations of the impact of immunization recommendations.^

Recommendations for dementia caregiver stress interventions based on Intervention Mapping guidelines

Stress can affect a person's psychological and physical health and cause a variety of conditions including depression, immune system changes, and hypertension (Alzheimer's Association, 2010; Aschbacher et al., 2009; Fredman et al., 2010; Long et al., 2004; Mills et al., 2009; von Känel et al., 2008). The severity and consequences of these conditions can vary based on the duration, amount, and sources of stress experienced by the individual (Black & Hyer, 2010; Coen et al., 1997; Conde-Sala et al., 2010; Pinquart & Sörensen, 2007). Caregivers of people with dementia have an elevated risk for stress and its related health problems because they experience more negative interactions with, and provide more emotional support for, their care recipients than other caregivers. ^ This paper uses a systematic program planning process of Intervention Mapping to organize evidence from literature, qualitative research and theory to develop recommendations for a theory- and evidence-based intervention to improve outcomes for caregivers of people with dementia. A needs assessment was conducted to identify specific dementia caregiver stress influences and a logic model of dementia caregiver stress was developed using the PRECEDE Model. Necessary behavior and environmental outcomes are identified for dementia caregiver stress reduction and performance objectives for each were combined with selected determinants to produce change objectives. Planning matrices were then designed to inform effective theory-based methods and practical applications for recommended intervention delivery. Recommendations for program components, their scope and sequence, the completed program materials, and the program protocols are delineated along with ways to insure that the program is adopted and implemented after it is shown to be effective.^

Climate change technology transfer to developing countries: evidence analysis and policy recommendations

Developing countries are experiencing unprecedented levels of economic growth. As a result, they will be responsible for most of the future growth in energy demand and greenhouse gas (GHG) emissions. Curbing GHG emissions in developing countries has become one of the cornerstones of a future international agreement under the United Nations Framework Convention for Climate Change (UNFCCC). However, setting caps for developing countries’ GHG emissions has encountered strong resistance in the current round of negotiations. Continued economic growth that allows poverty eradication is still the main priority for most developing countries, and caps are perceived as a constraint to future growth prospects. The development, transfer and use of low-carbon technologies have more positive connotations, and are seen as the potential path towards low-carbon development. So far, the success of the UNFCCC process in improving the levels of technology transfer (TT) to developing countries has been limited. This thesis analyses the causes for such limited success and seeks to improve on the understanding about what constitutes TT in the field of climate change, establish the factors that enable them in developing countries and determine which policies could be implemented to reinforce these factors. Despite the wide recognition of the importance of technology and knowledge transfer to developing countries in the climate change mitigation policy agenda, this issue has not received sufficient attention in academic research. Current definitions of climate change TT barely take into account the perspective of actors involved in actual climate change TT activities, while respective measurements do not bear in mind the diversity of channels through which these happen and the outputs and effects that they convey. Furthermore, the enabling factors for TT in non-BRIC (Brazil, Russia, India, China) developing countries have been seldom investigated, and policy recommendations to improve the level and quality of TTs to developing countries have not been adapted to the specific needs of highly heterogeneous countries, commonly denominated as “developing countries”. This thesis contributes to enriching the climate change TT debate from the perspective of a smaller emerging economy (Chile) and by undertaking a quantitative analysis of enabling factors for TT in a large sample of developing countries. Two methodological approaches are used to study climate change TT: comparative case study analysis and quantitative analysis. Comparative case studies analyse TT processes in ten cases based in Chile, all of which share the same economic, technological and policy frameworks, thus enabling us to draw conclusions on the enabling factors and obstacles operating in TT processes. The quantitative analysis uses three methodologies – principal component analysis, multiple regression analysis and cluster analysis – to assess the performance of developing countries in a number of enabling factors and the relationship between these factors and indicators of TT, as well as to create groups of developing countries with similar performances. The findings of this thesis are structured to provide responses to four main research questions: What constitutes technology transfer and how does it happen? Is it possible to measure technology transfer, and what are the main challenges in doing so? Which factors enable climate change technology transfer to developing countries? And how do different developing countries perform in these enabling factors, and how can differentiated policy priorities be defined accordingly? vi Resumen Los paises en desarrollo estan experimentando niveles de crecimiento economico sin precedentes. Como consecuencia, se espera que sean responsables de la mayor parte del futuro crecimiento global en demanda energetica y emisiones de Gases de Efecto de Invernadero (GEI). Reducir las emisiones de GEI en los paises en desarrollo es por tanto uno de los pilares de un futuro acuerdo internacional en el marco de la Convencion Marco de las Naciones Unidas para el Cambio Climatico (UNFCCC). La posibilidad de compromisos vinculantes de reduccion de emisiones de GEI ha sido rechazada por los paises en desarrollo, que perciben estos limites como frenos a su desarrollo economico y a su prioridad principal de erradicacion de la pobreza. El desarrollo, transferencia y uso de tecnologias bajas en carbono tiene connotaciones mas positivas y se percibe como la via hacia un crecimiento bajo en carbono. Hasta el momento, la UNFCCC ha tenido un exito limitado en la promocion de transferencias de tecnologia (TT) a paises en desarrollo. Esta tesis analiza las causas de este resultado y busca mejorar la comprension sobre que constituye transferencia de tecnologia en el area de cambio climatico, cuales son los factores que la facilitan en paises en desarrollo y que politicas podrian implementarse para reforzar dichos factores. A pesar del extendido reconocimiento sobre la importancia de la transferencia de tecnologia a paises en desarrollo en la agenda politica de cambio climatico, esta cuestion no ha sido suficientemente atendida por la investigacion existente. Las definiciones actuales de transferencia de tecnologia relacionada con la mitigacion del cambio climatico no tienen en cuenta la diversidad de canales por las que se manifiestan o los efectos que consiguen. Los factores facilitadores de TT en paises en desarrollo no BRIC (Brasil, Rusia, India y China) apenas han sido investigados, y las recomendaciones politicas para aumentar el nivel y la calidad de la TT no se han adaptado a las necesidades especificas de paises muy heterogeneos aglutinados bajo el denominado grupo de "paises en desarrollo". Esta tesis contribuye a enriquecer el debate sobre la TT de cambio climatico con la perspectiva de una economia emergente de pequeno tamano (Chile) y el analisis cuantitativo de factores que facilitan la TT en una amplia muestra de paises en desarrollo. Se utilizan dos metodologias para el estudio de la TT a paises en desarrollo: analisis comparativo de casos de estudio y analisis cuantitativo basado en metodos multivariantes. Los casos de estudio analizan procesos de TT en diez casos basados en Chile, para derivar conclusiones sobre los factores que facilitan u obstaculizan el proceso de transferencia. El analisis cuantitativo multivariante utiliza tres metodologias: regresion multiple, analisis de componentes principales y analisis cluster. Con dichas metodologias se busca analizar el posicionamiento de diversos paises en cuanto a factores que facilitan la TT; las relaciones entre dichos factores e indicadores de transferencia tecnologica; y crear grupos de paises con caracteristicas similares que podrian beneficiarse de politicas similares para la promocion de la transferencia de tecnologia. Los resultados de la tesis se estructuran en torno a cuatro preguntas de investigacion: .Que es la transferencia de tecnologia y como ocurre?; .Es posible medir la transferencia de tecnologias de bajo carbono?; .Que factores facilitan la transferencia de tecnologias de bajo carbono a paises en desarrollo? y .Como se puede agrupar a los paises en desarrollo en funcion de sus necesidades politicas para la promocion de la transferencia de tecnologias de bajo carbono?

Semantic Technology Recommendation Based on the Analytic Network Process

Semantic technologies have become widely adopted in recent years, and choosing the right technologies for the problems that users face is often a difficult task. This paper presents an application of the Analytic Network Process for the recommendation of semantic technologies, which is based on a quality model for semantic technologies. Instead of relying on expert-based comparisons of alternatives, the comparisons in our framework depend on real evaluation results. Furthermore, the recommendations in our framework derive from user quality requirements, which leads to better recommendations tailored to users’ needs. This paper also presents an algorithm for pairwise comparisons, which is based on user quality requirements and evaluation results.

Recommendations on seismic actions on bridges

The paper describes the main features of a technical Recommendation first draft on Seismic Actions on Bridges, promoted by the Spanish Ministry of Public Works (MOPT). Although much more research is needed to clarify the seismic behaviour of the vast class of problems present in port structures the current state of the art allows at least a classificaton of subjects and the establishment of minimum requirements to guide the design. Also the use of more refined methods for specially dangerous situations needs some general guidelines that contribute to mantein the design under reasonable safety margins. The Recommendations of the Spanish MOPT are a first try in those directions.

Recommendations on seismic actions on port structures

The paper describes the main features of a Technical Recommendation first draft on Seismic Action on port structures promoted recently by the Spanish Ministry of Public Works (MOPT). Although much more research is needed to clarify the seismic behaviour of the vast class of problems present in port structures the current state of the art allows at least a classification of subjects and the establishment of minimum requirements to guide the design. Also the use of more refined methods for specially dangerous situations needs some general guidelines that contribute to mantein the design under reasonable safety margins. The Recommendations of the Spanish MOPT are a first try in those directions.

Effects of dietary restriction combined with different exercise programs or physical activity recommendations on blood lipids in overweight adults

Background and aim: Many exercise studies, although generally showing the beneficial effects of supervised aerobic, resistance or combined exercise on blood lipids, have sometimes reached equivocal conclusions. The aim of this study is to evaluate the impact of different programs that combined exercise and dietary restriction on blood lipids versus a clinical practice intervention for weight loss, in overweight adults. Methods: For this study 66 subjects participated in a supervised 22 weeks training program, composed of three sessions per week and they were randomized in three groups: strength training (S; n = 19), endurance training (E; n = 25), a combination of E and S (SE; n = 22). Eighteen subjects served as physical activity group (PA) that followed a clinical intervention consisted of physical activity recommendations. All groups followed the same dietary treatment, and blood samples were obtained for lipids measurements, at the beginning and end of the study. Results: Lipid profile improved in all groups. No significant differences for baseline and post-training values were observed between groups. In general, SE and PA decreased low-density lipoprotein cholesterol (LDL-C) values (p menor que 0.01). S decreased triglyceride levels (p menor que 0.01) and E, SE, and PA decreased total cholesterol levels (p menor que 0.05, p menor que 0.01 and p menor que 0.01, respectively). Conclusions: These results suggest that an intervention program of supervised exercise combined with diet restriction did not achieved further improvements in blood lipid profile than diet restriction and physical activity recommendations, in overweight adults. (Clinical Trials gov number: NCT01116856).

Generating context-aware recommendations using banking data in a mobile recommender system

The increasing adoption of smartphones by the society has created a new area of research in recommender systems. This new domain is based on using location and context-awareness to provide personalization. This paper describes a model to generate context-aware recommendations for mobile recommender systems using banking data in order to recommend places where the bank customers have previously spent their money. In this work we have used real data provided by a well know Spanish bank. The mobile prototype deployed in the bank Labs environment was evaluated in a survey among 100 users with good results regarding usefulness and effectiveness. The results also showed that test users had a high confidence in a recommender system based on real banking data.

Enhanced recommendations for e-learning authoring tools based on a proactive context-aware recommender

Authoring tools are powerful systems in the area of e-Learning that make easier for teachers to create new learning objects by reusing or editing existing educational resources coming from learning repositories or content providers. However, due to the overwhelming number of resources these tools can access, sometimes it is difficult for teachers to find the most suitable resources taking into account their needs in terms of content (e.g. topic) or pedagogical aspects (e.g. target level associated to their students). Recommender systems can take an important role trying to mitigate this problem. In this paper we propose a new model to generate proactive context-aware recommendations on resources during the creation process of a new learning object that a teacher carries out by using an authoring tool. The common use cases covered by the model for having recommendations in online authoring tools and details about the recommender model itself are presented.

Parallel workflows to personalize clinical guidelines recommendations: application to gestational diabetes mellitus

The MobiGuide system provides patients with personalized decision support tools, based on computerized clinical guidelines, in a mobile environment. The generic capabilities of the system will be demonstrated applied to the clinical domain of Gestational Diabetes (GD). This paper presents a methodology to identify personalized recommendations, obtained from the analysis of the GD guideline. We added a conceptual parallel part to the formalization of the GD guideline called "parallel workflow" that allows considering patient?s personal context and preferences. As a result of analysing the GD guideline and eliciting medical knowledge, we identified three different types of personalized advices (therapy, measurements and upcoming events) that will be implemented to perform patients? guiding at home, supported by the MobiGuide system. These results will be essential to determine the distribution of functionalities between mobile and server decision support capabilities.

Soft solution fluorine-free synthesis of anatase nanoparticles with tailored morphology

TiO2 nanoparticles with tailored morphology have been synthesized under exceptionally soft conditions. The strategy is based on the use of a non-aqueous alcoholic reaction medium in which water traces, coming either from the air (atmospheric water) or from an ethanol–water azeotropic mixture (ethanol 96%), are incorporated in order to accelerate hydrolysis of the Ti–precursor. Moreover, organic surfactants have been used as capping agents so as to tailor crystal growth in certain preferential directions. Combinations of oleic acid and oleylamine, which lead to the formation of another surfactant, dioleamide, are employed instead of fluorine-based compounds, thus increasing the sustainability of the process. As a result, TiO2 nanostructured hierarchical microspheres and individual nanoparticles with exposed high-energy facets can be obtained at atmospheric pressure and temperatures as low as 78 °C.

The impact of the economic crisis and policy actions on GHG emissions from road transport in Spain

Road traffic is the greatest contributor to the carbon footprint of the transport sector and reducing it has become one of the main targets of sustainable transport policies. An analysis of the main factors influencing greenhouse gas (GHG) emissions is essential for designing new energy- and environmentally efficient strategies for the road transport. This paper addresses this need by (i) identifying factors which influence the carbon footprint, including traffic activity, fuel economy and socioeconomic development; and (ii) proposing a methodological framework which uses Modified Laspeyres Index decomposition to analyze the effect of important drivers on the changes in emissions of road transport in Spain during the period from 1990 to 2010. The results demonstrate that the country׳s economic growth has been closely linked to the rise in GHG emissions. The innovative contribution of this paper is the special analysis of the changes in mobility patterns and GHG emissions during the economic crisis, when, for the first time, Spanish road traffic emissions decreased. The reduction of road transport and improved energy efficiency has been powerful contributors to this decrease, demonstrating the effectiveness of energy-saving measures. On the basis of this analysis, several tailored policy recommendations have been suggested for future implementation.

Incorporating Group Recommendations to Recommender Systems: Alternatives and Performance

La importancia de los sistemas de recomendación ha experimentado un crecimiento exponencial como consecuencia del auge de las redes sociales. En esta tesis doctoral presentaré una amplia visión sobre el estado del arte de los sistemas de recomendación. Incialmente, estos estaba basados en fitrado demográfico, basado en contendio o colaborativo. En la actualidad, estos sistemas incorporan alguna información social al proceso de recomendación. En el futuro utilizarán información implicita, local y personal proveniente del Internet de las cosas. Los sistemas de recomendación basados en filtrado colaborativo se pueden modificar con el fin de realizar recomendaciones a grupos de usuarios. Existen trabajos previos que han incluido estas modificaciones en diferentes etapas del algoritmo de filtrado colaborativo: búsqueda de los vecinos, predicción de las votaciones y elección de las recomendaciones. En esta tesis doctoral proporcionaré un nuevo método que realizar el proceso de unficación (pasar de varios usuarios a un grupo) en el primer paso del algoritmo de filtrado colaborativo: cálculo de la métrica de similaridad. Proporcionaré una formalización completa del método propuesto. Explicaré cómo obtener el conjunto de k vecinos del grupo de usuarios y mostraré cómo obtener recomendaciones usando dichos vecinos. Asimismo, incluiré un ejemplo detallando cada paso del método propuesto en un sistema de recomendación compuesto por 8 usuarios y 10 items. Las principales características del método propuesto son: (a) es más rápido (más eficiente) que las alternativas proporcionadas por otros autores, y (b) es al menos tan exacto y preciso como otras soluciones estudiadas. Para contrastar esta hipótesis realizaré varios experimentos que miden la precisión, la exactitud y el rendimiento del método. Los resultados obtenidos se compararán con los resultados de otras alternativas utilizadas en la recomendación de grupos. Los experimentos se realizarán con las bases de datos de MovieLens y Netflix. ABSTRACT The importance of recommender systems has grown exponentially with the advent of social networks. In this PhD thesis I will provide a wide vision about the state of the art of recommender systems. They were initially based on demographic, contentbased and collaborative filtering. Currently, these systems incorporate some social information to the recommendation process. In the future, they will use implicit, local and personal information from the Internet of Things. As we will see here, recommender systems based on collaborative filtering can be used to perform recommendations to group of users. Previous works have made this modification in different stages of the collaborative filtering algorithm: establishing the neighborhood, prediction phase and determination of recommended items. In this PhD thesis I will provide a new method that carry out the unification process (many users to one group) in the first stage of the collaborative filtering algorithm: similarity metric computation. I will provide a full formalization of the proposed method. I will explain how to obtain the k nearest neighbors of the group of users and I will show how to get recommendations using those users. I will also include a running example of a recommender system with 8 users and 10 items detailing all the steps of the method I will present. The main highlights of the proposed method are: (a) it will be faster (more efficient) that the alternatives provided by other authors, and (b) it will be at least as precise and accurate as other studied solutions. To check this hypothesis I will conduct several experiments measuring the accuracy, the precision and the performance of my method. I will compare these results with the results generated by other methods of group recommendation. The experiments will be carried out using MovieLens and Netflix datasets.