Implementation status of error disclosure standards reported by Swiss hospitals

QUESTION UNDER STUDY To establish at what stage Swiss hospitals are in implementing an internal standard concerning communication with patients and families after an error that resulted in harm. METHODS Hospitals were identified via the Swiss Hospital Association's website. An anonymous questionnaire was sent during September and October 2011 to 379 hospitals in German, French or Italian. Hospitals were asked to specify their hospital type and the implementation status of an internal hospital standard that decrees that patients or their relatives are to be promptly informed about medical errors that result in harm. RESULTS Responses from a total of 205 hospitals were received, a response rate of 54%. Most responding hospitals (62%) had an error disclosure standard or planned to implement one within 12 months. The majority of responding university and acute care (75%) hospitals had introduced a disclosure standard or were planning to do so. In contrast, the majority of responding psychiatric, rehabilitation and specialty (53%) clinics had not introduced a standard. CONCLUSION It appears that Swiss hospitals are in a promising state in providing institutional support for practitioners disclosing medical errors to patients. This has been shown internationally to be one important factor in encouraging the disclosure of medical errors. However, many hospitals, in particular psychiatric, rehabilitation and specialty clinics, have not implemented an error disclosure policy. Further research is needed to explore the underlying reasons.

Current Resources

Reviews of: Treating the Tough Adolescent: A Family-Based Step-by-St Guide. (1998) Scott P. Sells. New York: The Guilford Press. Reviewed by John P. Nasuti Essential Skills in Family Therapy: From the First Interview to Termination. (1998) JoEllen Patterson, Lee Williams, Claudia Grauf-Grounds, and Larry Chamow. New York: The Guilford Press. Reviewed by Rowena Fong Putting Families First America's Family Support Movement and the Challenge of Change. (1994) Sharon L. Kagan and Bernice Weissbound, Editors. San Francisco: Jossey-Bass Publishers. Reviewed by Anthony N. Maluccio The Work-Family Challenge Rethinking Employment. Edited by Susan Lewis and Jeremy Lewis. 1996. Thousand Oaks, California: SAGE Publications, Ltd. Reviewed by Harry J. Macy

Disclosing and reporting medical errors: Cross-sectional survey of Swiss anaesthesiologists.

BACKGROUND There is limited research on anaesthesiologists' attitudes and experiences regarding medical error communication, particularly concerning disclosing errors to patients. OBJECTIVE To characterise anaesthesiologists' attitudes and experiences regarding disclosing errors to patients and reporting errors within the hospital, and to examine factors influencing their willingness to disclose or report errors. DESIGN Cross-sectional survey. SETTING Switzerland's five university hospitals' departments of anaesthesia in 2012/2013. PARTICIPANTS Two hundred and eighty-one clinically active anaesthesiologists. MAIN OUTCOME MEASURES Anaesthesiologists' attitudes and experiences regarding medical error communication. RESULTS The overall response rate of the survey was 52% (281/542). Respondents broadly endorsed disclosing harmful errors to patients (100% serious, 77% minor errors, 19% near misses), but also reported factors that might make them less likely to actually disclose such errors. Only 12% of respondents had previously received training on how to disclose errors to patients, although 93% were interested in receiving training. Overall, 97% of respondents agreed that serious errors should be reported, but willingness to report minor errors (74%) and near misses (59%) was lower. Respondents were more likely to strongly agree that serious errors should be reported if they also thought that their hospital would implement systematic changes after errors were reported [(odds ratio, 2.097 (95% confidence interval, 1.16 to 3.81)]. Significant differences in attitudes between departments regarding error disclosure and reporting were noted. CONCLUSION Willingness to disclose or report errors varied widely between hospitals. Thus, heads of department and hospital chiefs need to be aware of the importance of local culture when it comes to error communication. Error disclosure training and improving feedback on how error reports are being used to improve patient safety may also be important steps in increasing anaesthesiologists' communication of errors.

Na 1 Nachlass Max Horkheimer, 96 - Korrespondenzen u.a. mit Jürgen Habermas (p. III 6, 1-421)

5 Briefe mit Antwort an Inga Haag, 1951-1955; 1 Brief mit Antwort von Jürgen Habermas an Max Horkheimer, 1955; 1 Brief von Ministerialrat i. R. Theodor Häbich an Max Horkheimer, 1957; 2 Briefe mit Antwort von cand. phil. Walter Hähnle an Max Horkheimer, 1955, 1957; 1 Brief mit Antwort von Sekretärin Jutta Hagen an Max Horkheimer, 1956; 1 Dissertationsauszug von Volker Freiherr von Hagen, 1954; 1 Brief mit Antwort von Julia Hagenbucher an Max Horkheimer, 1951/1952; 1 Entwurf zu einem Gratulationsschreiben von Max Horkheimer an Professor Otto Hahn, ohne Jahr; 2 Drucksachen von Obermagistratsrat Julius Hahn, 1953, 1955; 1 Brief mit Antwort von Theodor W. Adorno, von Dr. Hans Hahn an Max Horkheimer, 1952; 1 Brief von Theodor W. Adorno an Dr. Hans Hahn, 1952; 1 Danksagung von Rabbi Hugo Hahn, 1955; 3 Briefe mit Antwort von Paul Hahn an Max Horkheimer, 1951-1958; 1 Brief von Max Horkheimer an die Gebrüder Haldy, 1952; 1 Brief mit Antwort und Beilage von Professor George W. F. Hallgarten an Max Horkheimer, 1950; 1 Rundschreiben von Arzt und Psychotherapeut Hans Hammer, 1957; 1 Brief von Max Horkheimer an Margarete Hampf-Solm, 1955; 1 Brief mit Antwort von Professor Eduardo Hamuy an Max Horkheimer, 1952; 1 Brief von der Stadtärztin Dr. med. Carola Hannappel an Max Horkheimer, 1951; 1 Brief von Hansenmeister an Max Horkheimer, 1951; 1 Brief mit Antwort und Beilage von der Buchhandlung Ludwig Häntzschel an Max Horkheimer, 1958; 1 Brief von Professor Frederick Harris Harbison an Max Horkheimer, 1952; 3 Briefe mit Antwort von Robert Harcourt an Max Horkheimer, 1958; 1 Brief von Karl Hardach an Max Horkheimer, 1957; 1 Brief mit Antwort von Emilie Harlacher an Max Horkheimer, 1952; 1 Drucksache mit Antwort von Oberkirchenrat Otto L. A. von Harling an Max Horkheimer, 1955; 1 Brief mit Antwort von Gertrud Harms an Max Horkheimer, 1955; 2 Brief mit Antwort von Professor Wolfgang Hartke an Max Horkheimer, 1954-1956; 2 Briefe mit antwort von Max Horkheimer an Senator Georg Hartmann, 1951, 1954; 3 briefe mit Antwort und Beilage von Ökonom Heinz Hartmann an Max Horkheimer, 1956-1958; 1 Brief mit Antwort von Professor Wilbert E. Moore an Max Horkheimer, 1957; 3 Briefe mit Antwort und Beilage von Dr. phil. Leo Hartmann an Max Horkheimer, 1957-1858; 1 Brief mit Antowort von Dr. phil. Eckardt Mesch an Max Horkheimer, 1957; 1 Brief mit Antwort von Luzie Hatch an Max Horkheimer, 1954; 1 Brief von Max Horkheimer an den Direktor H. W. Haupt, 1950; 1 Drucksache von Haus Schwalbach, 1951; 4 Briefe mit Antwort von Professor Gottfried und Ellen Hausmann an Max Horkheimer, 1951-1958; 6 Briefe mit Antwort von Eva Haussner an Max Horkheimer, 1957, 1958; 1 Brief mit Antwort von Professor Robert J. Havighurst an Max Horkheimer, 1951; 1 Brief mit Beilage von Herbert Hax an Max Horkheimer, 1955; 2 Briefe mit Antwort und Beilage von Jean Louis Hébarre an Max Horkheimer, 1950-1952; 1 Brief mit Antwort von dem Hebedienst für Elektrizität, Gas und Wasser an Max Horkheimer, 1951; 5 Briefe mit Antwort und Beilage von Professor Otto Heckmann an Max Horkheimer, 1952, 1954; 1 Brief von Melvin J. Lasky an August Heckscher, 1957; 3 Briefe mit Antwort von Marie Heep an Max Horkheimer, 1956-1858; 1 Brief von der Buchhandlung Thekla Heer an Max Horkheimer, 1953; 1 Brief mit Antwort von dem Verleger Jakob Hegner an Max Horkheimer, 1955; 1 Brief von Dr. phil. Rudolf M. Heilbrunn an Max Horkheimer, 1953; 1 Brief mit Antwort von Professor Eduard Heimann an Max Horkheimer, 1952; 1 Brief von Professor Eduard Heimann an Theodor W. Adorno, 1957; 1 Brief mit Antwort von stud. phil. Wolfgang Heinrich an Max Horkheimer, 1958; 1 Brief von Max Horkheimer an den Direktor Helmuth Heintzmann, 1955; 1 Aktennotiz von Professor Bernhard Heller, 1956; 1 Brief mit Antwort von Philipp A. Heller an Max Horkheimer, 1952; 1 Brief von Max Horkheimer an Assistent Winfried Hellmann, 1957; 2 Briefe mit Antwort von Professor Arthur Henkel an Max Horkheimer, 1953/1954; 1 Brief von Max Horkheiemr an Dorothy Henkel, 1952; 2 Briefe mit Antwort von Dr. jur. Werner Hennig an Max Horkheimer, 1951; 1 Brief von Max Horkheimer an Professor Wilhelm Hennis, 1957; 3 Briefe mit Antwort und Beilage von Professor Fritz Hepner an Max Horkheimer, 1953; 1 Brief von Max Horkheimer an den Hessischer Minister für Erziehung und Volksbildung, 1950; 1 Brief mit Antwort von Professor Henrietta Herbolsheimer an Max Horkheimer, 1957/1958; 2 Briefe mit Antwort von P. G. Herbst an Max Horkheimer, 1952; 1 Brief von Max Horkheimer an den Herder Verlag, 1953; 2 Briefe mit Antwort, Beilagen und Aktennotizen von Guenter R. Herz an Max Horkheimer, 1956-1957; 2 Briefe mit Antwort unv Beilagen von Professor Theodor W. Adorno, von Dr. phil. Günther Herzberg an Max Horkheimer, 1951-1953; 1 Brief von Professor Theodor W. Adrono an Dr. phil. Günther Herzberg, 1951; 1 Brief von Dr. phil. G. Herzfeld an Max Horkheimer, 1952; 1 Brief von dem Herzog-Film an Max Horkheimer, 1952; 1 Brief mit Antwort von Professor Theodor W. Adorno, von Professor Erich Herzog an Max Horkheimer, 1952; 1 Brief von Professor Theodor W. Adorno an Professor Erich Herzog, 1952; 1 Brief mit Antwort von dem Verlag Otto H. Hess an Max Horkheimer, 1954; 1 Brief von Professor Gerhard Hess an Max Horkheimer, 1953; 1 Drucksachevon dem Hessischer Arbeitsausschuss gegen Rekrutierung, 1952; 1 Brief mit Beilage von dem Hotel Hessischer Hof an Max Horkheimer, 1956; 1 Brief mit Antwort von dem Hessischer Landesverband für Erwachsenenbildung an Max Horkheimer, 1956; 2 Briefe mit Antwort und Beilage von Marc Heurgon an Max Horkheimer, 1958; 1 Brief mit Beilage von Ruth Heydebrand an Max Horkheimer, [1955]; 1 Brief mit Antwort von Professor Frederick W. J. Heuser an Max Horkheimer, 1954; 2 Briefe mit Antwort von Professor Joh Erich Heyde an Max Horkheimer, 1958; 1 Befürwortung von Wolf von Heydebrand an Max Horkheimer, 1954; 1 Brief mit Antwort von Professor Heinz Joachim Heydorn an Max Horkheimer, 1953; 1 Brief mit Antwort und Beilage von dem Arzt Otto Heymann an Max Horkheimer, 1955; 5 Briefe zwischen dem Devisenberater und Steuerhelfer Joseph Christ und Max Horkheimer, 1955, 1956, 1961; 1 Brief von dem Office of the United States High Commissioner for Germany an Max Horkheimer, 1953; 1 Lebenslauf von Elen B. Hill, ohne Jahr; 1 Brief von Kurt H. Wolff an Max Horkheimer, 1952; 1 Brief von Rolf Himmelreich an Max Horkheimer, 1956; 1 Brief mit Antwort von Dr. Rolf Hinder an Max Horkheimer, 1953; 1 Brief mit Antwort von Anton Hinsinger an Max Horkheimer, 1953; 1 Brief mit Antwort von dem Hippokrates-Verlag an Max Horkheimer, 1952; 1 Brief von Bernice L. Hirsch anMax Horkheimer, 1957; 4 Briefe und Beilagen zwischen dem Historiker und Soziologe Helmut Hirsch an Max Horkheimer, 1951-1954, 25.05.1951; 3 Briefe mit Antwort von Lux Hirsch an Max Horkheimer, 1958; 1 Brief mit Antwort von Trude Hirschberg an Max Horkheimer, 1951; 1 Brief mit Antwort von Ingineur Paul F. Hirschfelder an Max Horkheimer, 1952; 1 Brief von Johannes Hirzel an Max Horkheimer, 1955; 1 Brief mit Antwort von dem Historisches Seminar Köln an Max Horkheimer, 1956; 1 Brief mit Antwort und Beilage von Professor Wolfgang Hochheimer an Professor Theodor W. Adorno, 1952; 2 Briefe von Max Horkheimer an Professor Wolfgang Hochheimer, 1953, 1954; 2 Memoranden von der Deutschen Gesellschaft für Psychologie, 1953; 1 Brief mit Beilage von Stud. phil. Erna Hochleitner an Max Horkheimer, 1956; 1 Brief mit Antwort von Professor Helmut Coing an Max Horkheimer, 1957; 3 Briefe mit Antwort von der Hochschule für Sozialwissenschaften Wilhelmshaven an Max Horkheimer, 1957, 1958; 1 Brief von Max Horkheimer an die Hochschule für Wirtschafts- und Sozialwissenschaften Nürnberg, 1953; 2 Drucksachen von dem Hochschul-Dienst, 1952; 2 Drucksachen von der Hochschule für politische Wissenschaften München, 1952; 1 Brief mit Antwort von Dr. Wolfram Hodermann an Max Horkheimer, 1951; 4 Briefe zwischen Dr. phil. Walter Höllerer und Max Horkheimer, 1956; 1 Brief mit Antwort von Privatdozent Dr. phil. Walter Hoeres anMax Horkheimer, 1956; 2 Briefe mit Antwort von Stud. phil. Charlotte Hoffmann an Max Horkheimer, 1950; 3 Briefe mit Antwort und Beilage von Professor Walter Hoffmann an Max Horkheimer, 1950-1955; 1 Brief mit Antwort von Wolfhart E. V. Hoffmann an Max Horkheimer, 1953; 1 Brief von Max Horkheimer an Dr. Werner Hofmann, 1956; 1 Glückwunschtelegramm mit Antwort von Ernst und Karl Hohner, 1953; 1 Brief von Dozent Uvo Hölscher an Max Horkheimer, 1950; 2 Briefe mit Antwort von Professor Dr. med. K. Holldack an Max Horkheimer, 1957; 2 Briefe mit Antwort von Dipl. Landwirt Bernhard Hollenhorst an Max Horkheimer, 1956; 1 Brief von Hans Heinz Holz an Max Horkheimer, 1951; 2 Briefe mit Antwort und Beilage von Dr. phil. Rudolf Holzinger an Max Horkheimer, 1951, 1952; 1 Brief mit Antwort von Jakob Hommen an Max Horkheimer, 1953; 1 Brief von Adele Hoppe anMax Horkheimer, 1953; 1 Brief mit Antwort von Dr. jur. Anton Horn an Max Horkheimer, 1954; 1 Brief mit Antwort von Dr. phil. Emil Horn an Max Horkheimer, 1953; 1 Brief von der Landesabgeordneten Ruth Horn an H. Maidon, 1953; 1 Brief mit Antwort von Reg.-Direktor Dr. phil. Kurt Horstmann an Max Horkheimer, 1953; 1 Brief von dem Hotel Baur au Lac an H. Maidon, 1958; 2 Briefe mit 1 Antwort von dem Hotel Frankfurter Hof an Max Horkheimer, 1956, 1958; 1 Brief mit Antwort von dem Hotel Stafflenberg an H. Maidon, 1953; 1 Brief von dem Hotel Vier Jahreszeiten, München an Max Horkheimer, 1951; 1 Brief von Max Horkheimer an Jean J. Hubener, 1951; 2 Briefe mit Antwort und Beilage von Susanna Huber-Weisser an Max Horkheimer, 1956; 1 Todesanzeige von dem Sozialgerichtsdirektor Gustav Adolf Hünniger, 1955; 1 Brief von dem Oberstudiendirektor F. Huf an Max Horkheimer, 1952; 1 Brief mit Antwort von Professor H. D. Huggins an Max Horkheimer, 1954; 2 Briefe mit 1 Antwort und 1 Beilage von dem Humboldt-Verlag, Wien-Stuttgart an Max Horkheimer, 1951; 1 Brief von Helge Pross an stud. rer. pol. Kristian Hungar, 1957; 1 Brief von Helmut Hungerland an Max Horkheimer, 1950; 1 Brief mit Antwort von James R. Huntley an Max Horkheimer, 1954; 1 Brief von Professor Robert Maynard Hutchins an Max Horkheimer, 1957;

Anfangs-Buch, oder Ein Eingang zu größern Schulbüchern : Zum Gebrauch für kleine Kinder

verf. von Wilhelm W. Orwig

Cardiovascular disease risk factors in Hispanic children identified through a diabetic proband

Prevalence and mortality rates for non-insulin dependent (Type II) diabetes mellitus are two to five times greater in the Mexican-American population than in the general U.S. population. Diabetes has been associated with risk factors which increases the likelihood of developing atherosclerosis. Relatives of noninsulin dependent diabetic probands are at increased risk of developing diabetes; and offspring of diabetic parents are at greater risk. Elevation in risk factor levels clearly began to develop prior to adulthood. Therefore an excess of these risk factors are expected among offspring and relatives of diabetics.^ The purposes of this study were to describe levels of risk factors within a group of Mexican American children who were identified through a diabetic proband, and to determine if there was a relationship between risk factor levels and heritability. Data from three hundred and seventy-six children and adolescents between the ages of 7 and 13 years, inclusively, were analyzed. These children were identified through a diabetic proband who participated in the Diabetes Alert Study. This study group was compared to a representative sample of Mexican American children, who participated in the Hispanic Health and Nutrition Examination Survey.^ For females, there were statistically significant associations between upper body fat distribution and increased systolic and diastolic blood pressure after adjusting for age and measures of fatness. Body mass index was positively related to and explained a significant portion of the variability in systolic blood pressure, total cholesterol, and HDL-cholesterol, for males only. No relationship was found between degree of relationship to the diabetic proband and risk factor levels. The most likely explanations for this were insufficient sample size to detect differences, and/or incomplete ascertainment of pedigree information.^ Although there was evidence that these Mexican American children are fatter and have more central fat distribution than non-Hispanic children, there is no evidence of increased risk for diabetes and/or cardiovascular disease at these ages. ^

Subclavian vein catheter -related infection and hospital costs associated with exchange via a guidewire

An observational study was conducted in a SICU to determine the frequency of subclavian vein catheter-related infection at 72 hours, to identify the hospital cost of exchange via a guidewire and the estimated hospital cost-savings of a 72 hour vs 144 hour exchange policy.^ An overall catheter-related infection ($\geq$15 col. by Maki's technique (1977)) occurred in 3% (3/100) of the catheter tips cultured. Specific infections rates were: 9.7% (3/31) for triple lumen catheters, 0% (0/30) for Swan-Ganz catheters, 0% (0/30) for Cordes catheters, and 0% (0/9) for single lumen catheters.^ An estimated annual hospital cost-savings of $35,699.00 was identified if exchange of 72 hour policy were changed to every 144 hours.^ It was recommended that a randomized clinical trial be conducted to determine the effect of changing a subclavian vein catheter via a guidewire every 72 hours vs 144 hours. ^

Fauna hawaiiensis; being the land-fauna of the Hawaiian islands. by various authors, 1899-1913.

v. 1:pt. 6

Fauna hawaiiensis; being the land-fauna of the Hawaiian islands. by various authors, 1899-1913.

v. 1:pt. 2

Fauna hawaiiensis; being the land-fauna of the Hawaiian islands. by various authors, 1899-1913.

v. 1:pt. 3

Torpor in mice is induced by both leptin-dependent and -independent mechanisms

We tested the effect of chronic leptin treatment on fasting-induced torpor in leptin-deficient A-ZIP/F-1 and ob/ob mice. A-ZIP/F-1 mice have virtually no white adipose tissue and low leptin levels, whereas ob/ob mice have an abundance of fat but no leptin. These two models allowed us to examine the roles of adipose tissue and leptin in the regulation of entry into torpor. Torpor is a short-term hibernation-like state that allows conservation of metabolic fuels. We first characterized the A-ZIP/F-1 animals, which have a 10-fold reduction in total body triglyceride stores. Upon fasting, A-ZIP/F-1 mice develop a lower metabolic rate and decreased plasma glucose, insulin, and triglyceride levels, with no increase in free fatty acids or β-hydroxybutyrate. Unlike control mice, by 24 hr of fasting, they have nearly exhausted their triglycerides and are catabolizing protein. To conserve energy supplies during fasting, A-ZIP/F-1 (but not control) mice entered deep torpor, with a minimum core body temperature of 24°C, 2°C above ambient. In ob/ob mice, fasting-induced torpor was completely reversed by leptin treatment. In contrast, neither leptin nor thyroid hormone prevented torpor in A-ZIP/F-1 mice. These data suggest that there are at least two signals for entry into torpor in mice, a low leptin level and another signal that is independent of leptin and thyroid hormone levels. Studying rodent torpor provides insight into human torpor-like states such as near drowning in cold water and induced hypothermia for surgery.

Comparative mapping of the human 22q11 chromosomal region and the orthologous region in mice reveals complex changes in gene organization

The region of human chromosome 22q11 is prone to rearrangements. The resulting chromosomal abnormalities are involved in Velo-cardio-facial and DiGeorge syndromes (VCFS and DGS) (deletions), “cat eye” syndrome (duplications), and certain types of tumors (translocations). As a prelude to the development of mouse models for VCFS/DGS by generating targeted deletions in the mouse genome, we examined the organization of genes from human chromosome 22q11 in the mouse. Using genetic linkage analysis and detailed physical mapping, we show that genes from a relatively small region of human 22q11 are distributed on three mouse chromosomes (MMU6, MMU10, and MMU16). Furthermore, although the region corresponding to about 2.5 megabases of the VCFS/DGS critical region is located on mouse chromosome 16, the relative organization of the region is quite different from that in humans. Our results show that the instability of the 22q11 region is not restricted to humans but may have been present throughout evolution. The results also underscore the importance of detailed comparative mapping of genes in mice and humans as a prerequisite for the development of mouse models of human diseases involving chromosomal rearrangements.

Spermatogonial stem cell enrichment by multiparameter selection of mouse testis cells

The spermatogonial stem cell initiates and maintains spermatogenesis in the testis. To perform this role, the stem cell must self replicate as well as produce daughter cells that can expand and differentiate to form spermatozoa. Despite the central importance of the spermatogonial stem cell to male reproduction, little is known about its morphological or biochemical characteristics. This results, in part, from the fact that spermatogonial stem cells are an extremely rare cell population in the testis, and techniques for their enrichment are just beginning to be established. In this investigation, we used a multiparameter selection strategy, combining the in vivo cryptorchid testis model with in vitro fluorescence-activated cell sorting analysis. Cryptorchid testis cells were fractionated by fluorescence-activated cell sorting analysis based on light-scattering properties and expression of the cell surface molecules α6-integrin, αv-integrin, and the c-kit receptor. Two important observations emerged from these analyses. First, spermatogonial stem cells from the adult cryptorchid testis express little or no c-kit. Second, the most effective enrichment strategy, in this study, selected cells with low side scatter light-scattering properties, positive staining for α6-integrin, and negative or low αv-integrin expression, and resulted in a 166-fold enrichment of spermatogonial stem cells. Identification of these characteristics will allow further purification of these valuable cells and facilitate the investigation of molecular mechanisms governing spermatogonial stem cell self renewal and hierarchical differentiation.