WorldWideScience

Sample records for technology error patients

  1. Laboratory errors and patient safety.

    Science.gov (United States)

    Miligy, Dawlat A

    2015-01-01

    Laboratory data are extensively used in medical practice; consequently, laboratory errors have a tremendous impact on patient safety. Therefore, programs designed to identify and reduce laboratory errors, as well as, setting specific strategies are required to minimize these errors and improve patient safety. The purpose of this paper is to identify part of the commonly encountered laboratory errors throughout our practice in laboratory work, their hazards on patient health care and some measures and recommendations to minimize or to eliminate these errors. Recording the encountered laboratory errors during May 2008 and their statistical evaluation (using simple percent distribution) have been done in the department of laboratory of one of the private hospitals in Egypt. Errors have been classified according to the laboratory phases and according to their implication on patient health. Data obtained out of 1,600 testing procedure revealed that the total number of encountered errors is 14 tests (0.87 percent of total testing procedures). Most of the encountered errors lay in the pre- and post-analytic phases of testing cycle (representing 35.7 and 50 percent, respectively, of total errors). While the number of test errors encountered in the analytic phase represented only 14.3 percent of total errors. About 85.7 percent of total errors were of non-significant implication on patients health being detected before test reports have been submitted to the patients. On the other hand, the number of test errors that have been already submitted to patients and reach the physician represented 14.3 percent of total errors. Only 7.1 percent of the errors could have an impact on patient diagnosis. The findings of this study were concomitant with those published from the USA and other countries. This proves that laboratory problems are universal and need general standardization and bench marking measures. Original being the first data published from Arabic countries that

  2. Reducing Technology-Induced Errors: Organizational and Health Systems Approaches.

    Science.gov (United States)

    Borycki, Elizabeth M; Senthriajah, Yalini; Kushniruk, Andre W; Palojoki, Sari; Saranto, Kaija; Takeda, Hiroshi

    2016-01-01

    Technology-induced errors are a growing concern for health care organizations. Such errors arise from the interaction between healthcare and information technology deployed in complex settings and contexts. As the number of health information technologies that are used to provide patient care rises so will the need to develop ways to improve the quality and safety of the technology that we use. The objective of the panel is to describe varying approaches to improving software safety from and organizational and health systems perspective. We define what a technology-induced error is. Then, we discuss how software design and testing can be used to improve health information technologies. This discussion is followed by work in the area of monitoring and reporting at a health district and national level. Lastly, we draw on the quality, safety and resilience literature. The target audience for this work are nursing and health informatics researchers, practitioners, administrators, policy makers and students.

  3. Technology and medication errors: impact in nursing homes.

    Science.gov (United States)

    Baril, Chantal; Gascon, Viviane; St-Pierre, Liette; Lagacé, Denis

    2014-01-01

    The purpose of this paper is to study a medication distribution technology's (MDT) impact on medication errors reported in public nursing homes in Québec Province. The work was carried out in six nursing homes (800 patients). Medication error data were collected from nursing staff through a voluntary reporting process before and after MDT was implemented. The errors were analysed using: totals errors; medication error type; severity and patient consequences. A statistical analysis verified whether there was a significant difference between the variables before and after introducing MDT. The results show that the MDT detected medication errors. The authors' analysis also indicates that errors are detected more rapidly resulting in less severe consequences for patients. MDT is a step towards safer and more efficient medication processes. Our findings should convince healthcare administrators to implement technology such as electronic prescriber or bar code medication administration systems to improve medication processes and to provide better healthcare to patients. Few studies have been carried out in long-term healthcare facilities such as nursing homes. The authors' study extends what is known about MDT's impact on medication errors in nursing homes.

  4. Awareness of technology-induced errors and processes for identifying and preventing such errors.

    Science.gov (United States)

    Bellwood, Paule; Borycki, Elizabeth M; Kushniruk, Andre W

    2015-01-01

    There is a need to determine if organizations working with health information technology are aware of technology-induced errors and how they are addressing and preventing them. The purpose of this study was to: a) determine the degree of technology-induced error awareness in various Canadian healthcare organizations, and b) identify those processes and procedures that are currently in place to help address, manage, and prevent technology-induced errors. We identified a lack of technology-induced error awareness among participants. Participants identified there was a lack of well-defined procedures in place for reporting technology-induced errors, addressing them when they arise, and preventing them.

  5. Patient identification errors: the detective in the laboratory.

    Science.gov (United States)

    Salinas, Maria; López-Garrigós, Maite; Lillo, Rosa; Gutiérrez, Mercedes; Lugo, Javier; Leiva-Salinas, Carlos

    2013-11-01

    The eradication of errors regarding patients' identification is one of the main goals for safety improvement. As clinical laboratory intervenes in 70% of clinical decisions, laboratory safety is crucial in patient safety. We studied the number of Laboratory Information System (LIS) demographic data errors registered in our laboratory during one year. The laboratory attends a variety of inpatients and outpatients. The demographic data of outpatients is registered in the LIS, when they present to the laboratory front desk. The requests from the primary care centers (PCC) are made electronically by the general practitioner. A manual step is always done at the PCC to conciliate the patient identification number in the electronic request with the one in the LIS. Manual registration is done through hospital information system demographic data capture when patient's medical record number is registered in LIS. Laboratory report is always sent out electronically to the patient's electronic medical record. Daily, every demographic data in LIS is manually compared to the request form to detect potential errors. Fewer errors were committed when electronic order was used. There was great error variability between PCC when using the electronic order. LIS demographic data manual registration errors depended on patient origin and test requesting method. Even when using the electronic approach, errors were detected. There was a great variability between PCC even when using this electronic modality; this suggests that the number of errors is still dependent on the personnel in charge of the technology. © 2013.

  6. Medication errors: the role of the patient.

    Science.gov (United States)

    Britten, Nicky

    2009-06-01

    1. Patients and their carers will usually be the first to notice any observable problems resulting from medication errors. They will probably be unable to distinguish between medication errors, adverse drug reactions, or 'side effects'. 2. Little is known about how patients understand drug related problems or how they make attributions of adverse effects. Some research suggests that patients' cognitive models of adverse drug reactions bear a close relationship to models of illness perception. 3. Attributions of adverse drug reactions are related to people's previous experiences and to their level of education. The evidence suggests that on the whole patients' reports of adverse drug reactions are accurate. However, patients do not report all the problems they perceive and are more likely to report those that they do perceive as severe. Patients may not report problems attributed to their medications if they are fearful of doctors' reactions. Doctors may respond inappropriately to patients' concerns, for example by ignoring them. Some authors have proposed the use of a symptom checklist to elicit patients' reports of suspected adverse drug reactions. 4. Many patients want information about adverse drug effects, and the challenge for the professional is to judge how much information to provide and the best way of doing so. Professionals' inappropriate emphasis on adherence may be dangerous when a medication error has occurred. 5. Recent NICE guidelines recommend that professionals should ask patients if they have any concerns about their medicines, and this approach is likely to yield information conducive to the identification of medication errors.

  7. Near field communications technology and the potential to reduce medication errors through multidisciplinary application

    LENUS (Irish Health Repository)

    O’Connell, Emer

    2016-07-01

    Patient safety requires optimal management of medications. Electronic systems are encouraged to reduce medication errors. Near field communications (NFC) is an emerging technology that may be used to develop novel medication management systems.

  8. Technological Advancements and Error Rates in Radiation Therapy Delivery

    Energy Technology Data Exchange (ETDEWEB)

    Margalit, Danielle N., E-mail: dmargalit@partners.org [Harvard Radiation Oncology Program, Boston, MA (United States); Harvard Cancer Consortium and Brigham and Women' s Hospital/Dana Farber Cancer Institute, Boston, MA (United States); Chen, Yu-Hui; Catalano, Paul J.; Heckman, Kenneth; Vivenzio, Todd; Nissen, Kristopher; Wolfsberger, Luciant D.; Cormack, Robert A.; Mauch, Peter; Ng, Andrea K. [Harvard Cancer Consortium and Brigham and Women' s Hospital/Dana Farber Cancer Institute, Boston, MA (United States)

    2011-11-15

    Purpose: Technological advances in radiation therapy (RT) delivery have the potential to reduce errors via increased automation and built-in quality assurance (QA) safeguards, yet may also introduce new types of errors. Intensity-modulated RT (IMRT) is an increasingly used technology that is more technically complex than three-dimensional (3D)-conformal RT and conventional RT. We determined the rate of reported errors in RT delivery among IMRT and 3D/conventional RT treatments and characterized the errors associated with the respective techniques to improve existing QA processes. Methods and Materials: All errors in external beam RT delivery were prospectively recorded via a nonpunitive error-reporting system at Brigham and Women's Hospital/Dana Farber Cancer Institute. Errors are defined as any unplanned deviation from the intended RT treatment and are reviewed during monthly departmental quality improvement meetings. We analyzed all reported errors since the routine use of IMRT in our department, from January 2004 to July 2009. Fisher's exact test was used to determine the association between treatment technique (IMRT vs. 3D/conventional) and specific error types. Effect estimates were computed using logistic regression. Results: There were 155 errors in RT delivery among 241,546 fractions (0.06%), and none were clinically significant. IMRT was commonly associated with errors in machine parameters (nine of 19 errors) and data entry and interpretation (six of 19 errors). IMRT was associated with a lower rate of reported errors compared with 3D/conventional RT (0.03% vs. 0.07%, p = 0.001) and specifically fewer accessory errors (odds ratio, 0.11; 95% confidence interval, 0.01-0.78) and setup errors (odds ratio, 0.24; 95% confidence interval, 0.08-0.79). Conclusions: The rate of errors in RT delivery is low. The types of errors differ significantly between IMRT and 3D/conventional RT, suggesting that QA processes must be uniquely adapted for each technique

  9. Technological Advancements and Error Rates in Radiation Therapy Delivery

    International Nuclear Information System (INIS)

    Margalit, Danielle N.; Chen, Yu-Hui; Catalano, Paul J.; Heckman, Kenneth; Vivenzio, Todd; Nissen, Kristopher; Wolfsberger, Luciant D.; Cormack, Robert A.; Mauch, Peter; Ng, Andrea K.

    2011-01-01

    Purpose: Technological advances in radiation therapy (RT) delivery have the potential to reduce errors via increased automation and built-in quality assurance (QA) safeguards, yet may also introduce new types of errors. Intensity-modulated RT (IMRT) is an increasingly used technology that is more technically complex than three-dimensional (3D)–conformal RT and conventional RT. We determined the rate of reported errors in RT delivery among IMRT and 3D/conventional RT treatments and characterized the errors associated with the respective techniques to improve existing QA processes. Methods and Materials: All errors in external beam RT delivery were prospectively recorded via a nonpunitive error-reporting system at Brigham and Women’s Hospital/Dana Farber Cancer Institute. Errors are defined as any unplanned deviation from the intended RT treatment and are reviewed during monthly departmental quality improvement meetings. We analyzed all reported errors since the routine use of IMRT in our department, from January 2004 to July 2009. Fisher’s exact test was used to determine the association between treatment technique (IMRT vs. 3D/conventional) and specific error types. Effect estimates were computed using logistic regression. Results: There were 155 errors in RT delivery among 241,546 fractions (0.06%), and none were clinically significant. IMRT was commonly associated with errors in machine parameters (nine of 19 errors) and data entry and interpretation (six of 19 errors). IMRT was associated with a lower rate of reported errors compared with 3D/conventional RT (0.03% vs. 0.07%, p = 0.001) and specifically fewer accessory errors (odds ratio, 0.11; 95% confidence interval, 0.01–0.78) and setup errors (odds ratio, 0.24; 95% confidence interval, 0.08–0.79). Conclusions: The rate of errors in RT delivery is low. The types of errors differ significantly between IMRT and 3D/conventional RT, suggesting that QA processes must be uniquely adapted for each technique

  10. Reducing Diagnostic Errors through Effective Communication: Harnessing the Power of Information Technology

    Science.gov (United States)

    Naik, Aanand Dinkar; Rao, Raghuram; Petersen, Laura Ann

    2008-01-01

    Diagnostic errors are poorly understood despite being a frequent cause of medical errors. Recent efforts have aimed to advance the "basic science" of diagnostic error prevention by tracing errors to their most basic origins. Although a refined theory of diagnostic error prevention will take years to formulate, we focus on communication breakdown, a major contributor to diagnostic errors and an increasingly recognized preventable factor in medical mishaps. We describe a comprehensive framework that integrates the potential sources of communication breakdowns within the diagnostic process and identifies vulnerable steps in the diagnostic process where various types of communication breakdowns can precipitate error. We then discuss potential information technology-based interventions that may have efficacy in preventing one or more forms of these breakdowns. These possible intervention strategies include using new technologies to enhance communication between health providers and health systems, improve patient involvement, and facilitate management of information in the medical record. PMID:18373151

  11. Trends in Health Information Technology Safety: From Technology-Induced Errors to Current Approaches for Ensuring Technology Safety

    Science.gov (United States)

    2013-01-01

    Objectives Health information technology (HIT) research findings suggested that new healthcare technologies could reduce some types of medical errors while at the same time introducing classes of medical errors (i.e., technology-induced errors). Technology-induced errors have their origins in HIT, and/or HIT contribute to their occurrence. The objective of this paper is to review current trends in the published literature on HIT safety. Methods A review and synthesis of the medical and life sciences literature focusing on the area of technology-induced error was conducted. Results There were four main trends in the literature on technology-induced error. The following areas were addressed in the literature: definitions of technology-induced errors; models, frameworks and evidence for understanding how technology-induced errors occur; a discussion of monitoring; and methods for preventing and learning about technology-induced errors. Conclusions The literature focusing on technology-induced errors continues to grow. Research has focused on the defining what an error is, models and frameworks used to understand these new types of errors, monitoring of such errors and methods that can be used to prevent these errors. More research will be needed to better understand and mitigate these types of errors. PMID:23882411

  12. Patient identification errors are common in a simulated setting.

    Science.gov (United States)

    Henneman, Philip L; Fisher, Donald L; Henneman, Elizabeth A; Pham, Tuan A; Campbell, Megan M; Nathanson, Brian H

    2010-06-01

    We evaluate the frequency and accuracy of health care workers verifying patient identity before performing common tasks. The study included prospective, simulated patient scenarios with an eye-tracking device that showed where the health care workers looked. Simulations involved nurses administering an intravenous medication, technicians labeling a blood specimen, and clerks applying an identity band. Participants were asked to perform their assigned task on 3 simulated patients, and the third patient had a different date of birth and medical record number than the identity information on the artifact label specific to the health care workers' task. Health care workers were unaware that the focus of the study was patient identity. Sixty-one emergency health care workers participated--28 nurses, 16 technicians, and 17 emergency service associates--in 183 patient scenarios. Sixty-one percent of health care workers (37/61) caught the identity error (61% nurses, 94% technicians, 29% emergency service associates). Thirty-nine percent of health care workers (24/61) performed their assigned task on the wrong patient (39% nurses, 6% technicians, 71% emergency service associates). Eye-tracking data were available for 73% of the patient scenarios (133/183). Seventy-four percent of health care workers (74/100) failed to match the patient to the identity band (87% nurses, 49% technicians). Twenty-seven percent of health care workers (36/133) failed to match the artifact to the patient or the identity band before performing their task (33% nurses, 9% technicians, 33% emergency service associates). Fifteen percent (5/33) of health care workers who completed the steps to verify patient identity on the patient with the identification error still failed to recognize the error. Wide variation exists among health care workers verifying patient identity before performing everyday tasks. Education, process changes, and technology are needed to improve the frequency and accuracy of

  13. Preventing marine accidents caused by technology-induced human error

    OpenAIRE

    Bielić, Toni; Hasanspahić, Nermin; Čulin, Jelena

    2017-01-01

    The objective of embedding technology on board ships, to improve safety, is not fully accomplished. The paper studies marine accidents caused by human error resulting from improper human-technology interaction. The aim of the paper is to propose measures to prevent reoccurrence of such accidents. This study analyses the marine accident reports issued by Marine Accidents Investigation Branch covering the period from 2012 to 2014. The factors that caused these accidents are examined and categor...

  14. A framework to classify error in animal-borne technologies

    NARCIS (Netherlands)

    Burns, Z.T.; van Loon, E.E.

    2015-01-01

    The deployment of novel, innovative, and increasingly miniaturized devices on fauna to collect data has increased. Yet, every animal-borne technology has its shortcomings, such as limitations in its precision or accuracy. These shortcomings, here labeled as “error,” are not yet studied

  15. Putting a face on medical errors: a patient perspective.

    Science.gov (United States)

    Kooienga, Sarah; Stewart, Valerie T

    2011-01-01

    Knowledge of the patient's perspective on medical error is limited. Research efforts have centered on how best to disclose error and how patients desire to have medical error disclosed. On the basis of a qualitative descriptive component of a mixed method study, a purposive sample of 30 community members told their stories of medical error. Their experiences focused on lack of communication, missed communication, or provider's poor interpersonal style of communication, greatly contrasting with the formal definition of error as failure to follow a set standard of care. For these participants, being a patient was more important than error or how an error is disclosed. The patient's understanding of error must be a key aspect of any quality improvement strategy. © 2010 National Association for Healthcare Quality.

  16. Technology-related medication errors in a tertiary hospital: a 5-year analysis of reported medication incidents.

    Science.gov (United States)

    Samaranayake, N R; Cheung, S T D; Chui, W C M; Cheung, B M Y

    2012-12-01

    Healthcare technology is meant to reduce medication errors. The objective of this study was to assess unintended errors related to technologies in the medication use process. Medication incidents reported from 2006 to 2010 in a main tertiary care hospital were analysed by a pharmacist and technology-related errors were identified. Technology-related errors were further classified as socio-technical errors and device errors. This analysis was conducted using data from medication incident reports which may represent only a small proportion of medication errors that actually takes place in a hospital. Hence, interpretation of results must be tentative. 1538 medication incidents were reported. 17.1% of all incidents were technology-related, of which only 1.9% were device errors, whereas most were socio-technical errors (98.1%). Of these, 61.2% were linked to computerised prescription order entry, 23.2% to bar-coded patient identification labels, 7.2% to infusion pumps, 6.8% to computer-aided dispensing label generation and 1.5% to other technologies. The immediate causes for technology-related errors included, poor interface between user and computer (68.1%), improper procedures or rule violations (22.1%), poor interface between user and infusion pump (4.9%), technical defects (1.9%) and others (3.0%). In 11.4% of the technology-related incidents, the error was detected after the drug had been administered. A considerable proportion of all incidents were technology-related. Most errors were due to socio-technical issues. Unintended and unanticipated errors may happen when using technologies. Therefore, when using technologies, system improvement, awareness, training and monitoring are needed to minimise medication errors. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  17. Medication errors : the impact of prescribing and transcribing errors on preventable harm in hospitalised patients

    NARCIS (Netherlands)

    van Doormaal, J.E.; van der Bemt, P.M.L.A.; Mol, P.G.M.; Egberts, A.C.G.; Haaijer-Ruskamp, F.M.; Kosterink, J.G.W.; Zaal, Rianne J.

    Background: Medication errors (MEs) affect patient safety to a significant extent. Because these errors can lead to preventable adverse drug events (pADEs), it is important to know what type of ME is the most prevalent cause of these pADEs. This study determined the impact of the various types of

  18. Near field communications technology and the potential to reduce medication errors through multidisciplinary application.

    Science.gov (United States)

    O'Connell, Emer; Pegler, Joe; Lehane, Elaine; Livingstone, Vicki; McCarthy, Nora; Sahm, Laura J; Tabirca, Sabin; O'Driscoll, Aoife; Corrigan, Mark

    2016-01-01

    Patient safety requires optimal management of medications. Electronic systems are encouraged to reduce medication errors. Near field communications (NFC) is an emerging technology that may be used to develop novel medication management systems. An NFC-based system was designed to facilitate prescribing, administration and review of medications commonly used on surgical wards. Final year medical, nursing, and pharmacy students were recruited to test the electronic system in a cross-over observational setting on a simulated ward. Medication errors were compared against errors recorded using a paper-based system. A significant difference in the commission of medication errors was seen when NFC and paper-based medication systems were compared. Paper use resulted in a mean of 4.09 errors per prescribing round while NFC prescribing resulted in a mean of 0.22 errors per simulated prescribing round (P=0.000). Likewise, medication administration errors were reduced from a mean of 2.30 per drug round with a Paper system to a mean of 0.80 errors per round using NFC (PNFC based medication system may be used to effectively reduce medication errors in a simulated ward environment.

  19. Learning from errors in radiology to improve patient safety.

    Science.gov (United States)

    Saeed, Shaista Afzal; Masroor, Imrana; Shafqat, Gulnaz

    2013-10-01

    To determine the views and practices of trainees and consultant radiologists about error reporting. Cross-sectional survey. Radiology trainees and consultant radiologists in four tertiary care hospitals in Karachi approached in the second quarter of 2011. Participants were enquired as to their grade, sub-specialty interest, whether they kept a record/log of their errors (defined as a mistake that has management implications for the patient), number of errors they made in the last 12 months and the predominant type of error. They were also asked about the details of their department error meetings. All duly completed questionnaires were included in the study while the ones with incomplete information were excluded. A total of 100 radiologists participated in the survey. Of them, 34 were consultants and 66 were trainees. They had a wide range of sub-specialty interest like CT, Ultrasound, etc. Out of the 100 responders, 49 kept a personal record/log of their errors. In response to the recall of approximate errors they made in the last 12 months, 73 (73%) of participants recorded a varied response with 1 - 5 errors mentioned by majority i.e. 47 (64.5%). Most of the radiologists (97%) claimed receiving information about their errors through multiple sources like morbidity/mortality meetings, patients' follow-up, through colleagues and consultants. Perceptual error 66 (66%) were the predominant error type reported. Regular occurrence of error meetings and attending three or more error meetings in the last 12 months was reported by 35% participants. Majority among these described the atmosphere of these error meetings as informative and comfortable (n = 22, 62.8%). It is of utmost importance to develop a culture of learning from mistakes by conducting error meetings and improving the process of recording and addressing errors to enhance patient safety.

  20. Errors in imaging patients in the emergency setting.

    Science.gov (United States)

    Pinto, Antonio; Reginelli, Alfonso; Pinto, Fabio; Lo Re, Giuseppe; Midiri, Federico; Muzj, Carlo; Romano, Luigia; Brunese, Luca

    2016-01-01

    Emergency and trauma care produces a "perfect storm" for radiological errors: uncooperative patients, inadequate histories, time-critical decisions, concurrent tasks and often junior personnel working after hours in busy emergency departments. The main cause of diagnostic errors in the emergency department is the failure to correctly interpret radiographs, and the majority of diagnoses missed on radiographs are fractures. Missed diagnoses potentially have important consequences for patients, clinicians and radiologists. Radiologists play a pivotal role in the diagnostic assessment of polytrauma patients and of patients with non-traumatic craniothoracoabdominal emergencies, and key elements to reduce errors in the emergency setting are knowledge, experience and the correct application of imaging protocols. This article aims to highlight the definition and classification of errors in radiology, the causes of errors in emergency radiology and the spectrum of diagnostic errors in radiography, ultrasonography and CT in the emergency setting.

  1. Disclosing harmful medical errors to patients: tackling three tough cases.

    Science.gov (United States)

    Gallagher, Thomas H; Bell, Sigall K; Smith, Kelly M; Mello, Michelle M; McDonald, Timothy B

    2009-09-01

    A gap exists between recommendations to disclose errors to patients and current practice. This gap may reflect important, yet unanswered questions about implementing disclosure principles. We explore some of these unanswered questions by presenting three real cases that pose challenging disclosure dilemmas. The first case involves a pancreas transplant that failed due to the pancreas graft being discarded, an error that was not disclosed partly because the family did not ask clarifying questions. Relying on patient or family questions to determine the content of disclosure is problematic. We propose a standard of materiality that can help clinicians to decide what information to disclose. The second case involves a fatal diagnostic error that the patient's widower was unaware had happened. The error was not disclosed out of concern that disclosure would cause the widower more harm than good. This case highlights how institutions can overlook patients' and families' needs following errors and emphasizes that benevolent deception has little role in disclosure. Institutions should consider whether involving neutral third parties could make disclosures more patient centered. The third case presents an intraoperative cardiac arrest due to a large air embolism where uncertainty around the clinical event was high and complicated the disclosure. Uncertainty is common to many medical errors but should not deter open conversations with patients and families about what is and is not known about the event. Continued discussion within the medical profession about applying disclosure principles to real-world cases can help to better meet patients' and families' needs following medical errors.

  2. Error identification and recovery by student nurses using human patient simulation: opportunity to improve patient safety.

    Science.gov (United States)

    Henneman, Elizabeth A; Roche, Joan P; Fisher, Donald L; Cunningham, Helene; Reilly, Cheryl A; Nathanson, Brian H; Henneman, Philip L

    2010-02-01

    This study examined types of errors that occurred or were recovered in a simulated environment by student nurses. Errors occurred in all four rule-based error categories, and all students committed at least one error. The most frequent errors occurred in the verification category. Another common error was related to physician interactions. The least common errors were related to coordinating information with the patient and family. Our finding that 100% of student subjects committed rule-based errors is cause for concern. To decrease errors and improve safe clinical practice, nurse educators must identify effective strategies that students can use to improve patient surveillance. Copyright 2010 Elsevier Inc. All rights reserved.

  3. Medication Administration Errors Involving Paediatric In-Patients in a ...

    African Journals Online (AJOL)

    Erah

    In-Patients in a Hospital in Ethiopia. Yemisirach Feleke ... Purpose: To assess the type and frequency of medication administration errors (MAEs) in the paediatric ward of .... prescribers, does not go beyond obeying ... specialists, 43 general practitioners, 2 health officers ..... Medication Errors, International Council of Nurses.

  4. Errors in practical measurement in surveying, engineering, and technology

    International Nuclear Information System (INIS)

    Barry, B.A.; Morris, M.D.

    1991-01-01

    This book discusses statistical measurement, error theory, and statistical error analysis. The topics of the book include an introduction to measurement, measurement errors, the reliability of measurements, probability theory of errors, measures of reliability, reliability of repeated measurements, propagation of errors in computing, errors and weights, practical application of the theory of errors in measurement, two-dimensional errors and includes a bibliography. Appendices are included which address significant figures in measurement, basic concepts of probability and the normal probability curve, writing a sample specification for a procedure, classification, standards of accuracy, and general specifications of geodetic control surveys, the geoid, the frequency distribution curve and the computer and calculator solution of problems

  5. Errors in laboratory medicine: practical lessons to improve patient safety.

    Science.gov (United States)

    Howanitz, Peter J

    2005-10-01

    Patient safety is influenced by the frequency and seriousness of errors that occur in the health care system. Error rates in laboratory practices are collected routinely for a variety of performance measures in all clinical pathology laboratories in the United States, but a list of critical performance measures has not yet been recommended. The most extensive databases describing error rates in pathology were developed and are maintained by the College of American Pathologists (CAP). These databases include the CAP's Q-Probes and Q-Tracks programs, which provide information on error rates from more than 130 interlaboratory studies. To define critical performance measures in laboratory medicine, describe error rates of these measures, and provide suggestions to decrease these errors, thereby ultimately improving patient safety. A review of experiences from Q-Probes and Q-Tracks studies supplemented with other studies cited in the literature. Q-Probes studies are carried out as time-limited studies lasting 1 to 4 months and have been conducted since 1989. In contrast, Q-Tracks investigations are ongoing studies performed on a yearly basis and have been conducted only since 1998. Participants from institutions throughout the world simultaneously conducted these studies according to specified scientific designs. The CAP has collected and summarized data for participants about these performance measures, including the significance of errors, the magnitude of error rates, tactics for error reduction, and willingness to implement each of these performance measures. A list of recommended performance measures, the frequency of errors when these performance measures were studied, and suggestions to improve patient safety by reducing these errors. Error rates for preanalytic and postanalytic performance measures were higher than for analytic measures. Eight performance measures were identified, including customer satisfaction, test turnaround times, patient identification

  6. Wooing patients with technology.

    Science.gov (United States)

    Myers, Michael

    2013-04-01

    Technologies that can give healthcare organizations a marketing advantage with patients include: Registration kiosks that request payment automatically, in a more comfortable environment for both patients and registration staff. Emails that enable patients to schedule initial visits and follow-up care. Secure online messaging platforms that enable patients to obtain timely answers to questions they have for their providers both before and after receiving services.

  7. Treatment delay and radiological errors in patients with bone metastases

    International Nuclear Information System (INIS)

    Ichinohe, K.; Takahashi, M.; Tooyama, N.

    2003-01-01

    During routine investigations, we are surprised to find that therapy for bone metastases is sometimes delayed for a considerable period of time. To determine the extent of this delay and its causes, we reviewed the medical records of symptomatic patients seen at our hospital who had been recently diagnosed as having bone metastases for the last four years. The treatment delay was defined as the interval between presentation with symptoms and definitive treatment for bone metastases. The diagnostic delay was defined as the interval between presentation with symptoms and diagnosis of bone metastases. The results of diagnostic radiological examinations were also reviewed for errors. The study population included 76 males and 34 females with a median age of 66 years. Most bone metastases were diagnosed radiologically. Over 75% of patients were treated with radiotherapy. The treatment delay ranged from 2 to 307 days, with a mean of 53.3 days. In 490 radiological studies reviewed, we identified 166 (33.9%) errors concerning 62 (56.4%) patients. The diagnostic delay was significantly longer for patients with radiological errors than for patients without radiological errors (P < 0.001), and much of it was due to radiological errors. In conclusion, the treatment delay in patients with symptomatic bone metastases was much longer than expected, and much of it was caused by radiological errors. Considerable efforts should therefore be made to more carefully examine the radiological studies in order to ensure prompt treatment of bone metastases. (author)

  8. Refractive errors in presbyopic patients in Kano, Nigeria

    African Journals Online (AJOL)

    Annals of African Medicine, Vol. ... Information extracted includes patient's age, sex, and types of refractive error. ... All patients had basic eye examination and streak retinoscopy at two third meter working distance. ... symptoms may start earlier or later than this age .... presbyopia was associated with reduced workers'.

  9. Detection of Patients at High Risk of Medication Errors

    DEFF Research Database (Denmark)

    Sædder, Eva Aggerholm; Lisby, Marianne; Nielsen, Lars Peter

    2016-01-01

    Medication errors (MEs) are preventable and can result in patient harm and increased expenses in the healthcare system in terms of hospitalization, prolonged hospitalizations and even death. We aimed to develop a screening tool to detect acutely admitted patients at low or high risk of MEs...

  10. Patients' knowledge and perceived reactions to medical errors in a ...

    African Journals Online (AJOL)

    Severity of error (88.5%) and the perception of negligence mediated intention to litigate. Voluntary disclosure significantly reduced patients' intention to litigate caregivers (chi2=3.584; df=1; P=0.053). Frustration/anger was not more likely to influence patient to litigate than feelings of resignation/forgiveness (chi2=2.156; df=1; ...

  11. Reduction in specimen labeling errors after implementation of a positive patient identification system in phlebotomy.

    Science.gov (United States)

    Morrison, Aileen P; Tanasijevic, Milenko J; Goonan, Ellen M; Lobo, Margaret M; Bates, Michael M; Lipsitz, Stuart R; Bates, David W; Melanson, Stacy E F

    2010-06-01

    Ensuring accurate patient identification is central to preventing medical errors, but it can be challenging. We implemented a bar code-based positive patient identification system for use in inpatient phlebotomy. A before-after design was used to evaluate the impact of the identification system on the frequency of mislabeled and unlabeled samples reported in our laboratory. Labeling errors fell from 5.45 in 10,000 before implementation to 3.2 in 10,000 afterward (P = .0013). An estimated 108 mislabeling events were prevented by the identification system in 1 year. Furthermore, a workflow step requiring manual preprinting of labels, which was accompanied by potential labeling errors in about one quarter of blood "draws," was removed as a result of the new system. After implementation, a higher percentage of patients reported having their wristband checked before phlebotomy. Bar code technology significantly reduced the rate of specimen identification errors.

  12. ERROR ANALYSIS ON INFORMATION AND TECHNOLOGY STUDENTS’ SENTENCE WRITING ASSIGNMENTS

    Directory of Open Access Journals (Sweden)

    Rentauli Mariah Silalahi

    2015-03-01

    Full Text Available Students’ error analysis is very important for helping EFL teachers to develop their teaching materials, assessments and methods. However, it takes much time and effort from the teachers to do such an error analysis towards their students’ language. This study seeks to identify the common errors made by 1 class of 28 freshmen students studying English in their first semester in an IT university. The data is collected from their writing assignments for eight consecutive weeks. The errors found were classified into 24 types and the top ten most common errors committed by the students were article, preposition, spelling, word choice, subject-verb agreement, auxiliary verb, plural form, verb form, capital letter, and meaningless sentences. The findings about the students’ frequency of committing errors were, then, contrasted to their midterm test result and in order to find out the reasons behind the error recurrence; the students were given some questions to answer in a questionnaire format. Most of the students admitted that careless was the major reason for their errors and lack understanding came next. This study suggests EFL teachers to devote their time to continuously check the students’ language by giving corrections so that the students can learn from their errors and stop committing the same errors.

  13. Decreasing patient identification band errors by standardizing processes.

    Science.gov (United States)

    Walley, Susan Chu; Berger, Stephanie; Harris, Yolanda; Gallizzi, Gina; Hayes, Leslie

    2013-04-01

    Patient identification (ID) bands are an essential component in patient ID. Quality improvement methodology has been applied as a model to reduce ID band errors although previous studies have not addressed standardization of ID bands. Our specific aim was to decrease ID band errors by 50% in a 12-month period. The Six Sigma DMAIC (define, measure, analyze, improve, and control) quality improvement model was the framework for this study. ID bands at a tertiary care pediatric hospital were audited from January 2011 to January 2012 with continued audits to June 2012 to confirm the new process was in control. After analysis, the major improvement strategy implemented was standardization of styles of ID bands and labels. Additional interventions included educational initiatives regarding the new ID band processes and disseminating institutional and nursing unit data. A total of 4556 ID bands were audited with a preimprovement ID band error average rate of 9.2%. Significant variation in the ID band process was observed, including styles of ID bands. Interventions were focused on standardization of the ID band and labels. The ID band error rate improved to 5.2% in 9 months (95% confidence interval: 2.5-5.5; P error rates. This decrease in ID band error rates was maintained over the subsequent 8 months.

  14. The Impact of Bar Code Medication Administration Technology on Reported Medication Errors

    Science.gov (United States)

    Holecek, Andrea

    2011-01-01

    The use of bar-code medication administration technology is on the rise in acute care facilities in the United States. The technology is purported to decrease medication errors that occur at the point of administration. How significantly this technology affects actual rate and severity of error is unknown. This descriptive, longitudinal research…

  15. Contribution of refractive errors to visual impairment in patients at ...

    African Journals Online (AJOL)

    Objective: To determine the contribution of refractive error to visual impairment in visually impaired patients attending Korle-Bu Teaching Hospital, Ghana. Method: This study was conducted over a period of 1 year beginning October 2002 at Korle-Bu Teaching Hospital. Every 4th consecutive new case attending the eye ...

  16. Patient safety and technology-driven medication

    DEFF Research Database (Denmark)

    Orbæk, Janne; Gaard, Mette; Keinicke Fabricius, Pia

    2015-01-01

    ways of educating nursing students in today's medication administration. AIM: To explore nursing students' experiences and competences with the technology-driven medication administration process. METHODS: 16 pre-graduate nursing students were included in two focus group interviews which were recorded...... for the technology-driven medication process, nursing students face difficulties in identifying and adopting best practices. The impact of using technology on the frequency, type and severity of medication errors; the technologies implications on nursing professionalism and the nurses ability to secure patient...

  17. Sporadic error probability due to alpha particles in dynamic memories of various technologies

    International Nuclear Information System (INIS)

    Edwards, D.G.

    1980-01-01

    The sensitivity of MOS memory components to errors induced by alpha particles is expected to increase with integration level. The soft error rate of a 65-kbit VMOS memory has been compared experimentally with that of three field-proven 16-kbit designs. The technological and design advantages of the VMOS RAM ensure an error rate which is lower than those of the 16-kbit memories. Calculation of the error probability for the 65-kbit RAM and comparison with the measurements show that for large duty cycles single particle hits lead to sensing errors and for small duty cycles cell errors caused by multiple hits predominate. (Auth.)

  18. Optimization of intelligent infusion pump technology to minimize vasopressor pump programming errors.

    Science.gov (United States)

    Vadiei, Nina; Shuman, Carrie A; Murthy, Manasa S; Daley, Mitchell J

    2017-08-01

    There is a lack of data evaluating the impact of hard limit implementation into intelligent infusion pump technology (IIPT). The purpose of this study was to determine if incorporation of vasopressor upper hard limits (UHL) into IIPT increases efficacy of alerts by preventing pump programming errors. Retrospective review from five hospitals within a single healthcare network between April 1, 2013 and May 31, 2014. A total of 65,680 vasopressor data entries were evaluated; 19,377 prior to hard limit implementation and 46,303 after hard limit implementation. The primary outcome was the percent of effective alerts. The secondary outcome was the proportional dose increase from the soft limit provided. A reduction in alert rate occurred after incorporation of hard limits to the IIPT drug library (pre-UHL 4.7% vs. post-UHL 4.0%) with a subsequent increase in the number of errors prevented as represented by a higher effective alert rate (pre-UHL 23.0% vs. post-UHL 37.3%; p < 0.001). The proportional dose increase was significantly reduced (pre-UHL 188% ± 380%] vs. post-UHL 95% ± 128%; p < 0.001). Incorporation of UHLs into IIPT in a multi-site health system with varying intensive care unit and emergency department acuity increases alert effectiveness, reduces dosing errors, and reduces the magnitude of dosing errors that reach the patient.

  19. [Errors in medicine. Causes, impact and improvement measures to improve patient safety].

    Science.gov (United States)

    Waeschle, R M; Bauer, M; Schmidt, C E

    2015-09-01

    The guarantee of quality of care and patient safety is of major importance in hospitals even though increased economic pressure and work intensification are ubiquitously present. Nevertheless, adverse events still occur in 3-4 % of hospital stays and of these 25-50 % are estimated to be avoidable. The identification of possible causes of error and the development of measures for the prevention of medical errors are essential for patient safety. The implementation and continuous development of a constructive culture of error tolerance are fundamental.The origins of errors can be differentiated into systemic latent and individual active causes and components of both categories are typically involved when an error occurs. Systemic causes are, for example out of date structural environments, lack of clinical standards and low personnel density. These causes arise far away from the patient, e.g. management decisions and can remain unrecognized for a long time. Individual causes involve, e.g. confirmation bias, error of fixation and prospective memory failure. These causes have a direct impact on patient care and can result in immediate injury to patients. Stress, unclear information, complex systems and a lack of professional experience can promote individual causes. Awareness of possible causes of error is a fundamental precondition to establishing appropriate countermeasures.Error prevention should include actions directly affecting the causes of error and includes checklists and standard operating procedures (SOP) to avoid fixation and prospective memory failure and team resource management to improve communication and the generation of collective mental models. Critical incident reporting systems (CIRS) provide the opportunity to learn from previous incidents without resulting in injury to patients. Information technology (IT) support systems, such as the computerized physician order entry system, assist in the prevention of medication errors by providing

  20. Medication Administration Errors Involving Paediatric In-Patients in a ...

    African Journals Online (AJOL)

    The drug mostly associated with error was gentamicin with 29 errors (1.2 %). Conclusion: During the study, a high frequency of error was observed. There is a need to modify the way information is handled and shared by professionals as wrong time error was the most implicated error. Attention should also be given to IV ...

  1. Analysis on two technologic errors of color separation grating used for ICF

    International Nuclear Information System (INIS)

    Chen Dewei; Li Yongping

    2003-01-01

    In this paper, the depth of color separation grating applied in ICF system is optimized firstly for good separating effect. After this, duty cycle error and the trapezoid structure are analyzed. A probable scope of technologic error that make the color separation grating have good effect is given in the end

  2. Improving patient safety in radiotherapy through error reporting and analysis

    International Nuclear Information System (INIS)

    Findlay, Ú.; Best, H.; Ottrey, M.

    2016-01-01

    Aim: To improve patient safety in radiotherapy (RT) through the analysis and publication of radiotherapy errors and near misses (RTE). Materials and methods: RTE are submitted on a voluntary basis by NHS RT departments throughout the UK to the National Reporting and Learning System (NRLS) or directly to Public Health England (PHE). RTE are analysed by PHE staff using frequency trend analysis based on the classification and pathway coding from Towards Safer Radiotherapy (TSRT). PHE in conjunction with the Patient Safety in Radiotherapy Steering Group publish learning from these events, on a triannual and summarised on a biennial basis, so their occurrence might be mitigated. Results: Since the introduction of this initiative in 2010, over 30,000 (RTE) reports have been submitted. The number of RTE reported in each biennial cycle has grown, ranging from 680 (2010) to 12,691 (2016) RTE. The vast majority of the RTE reported are lower level events, thus not affecting the outcome of patient care. Of the level 1 and 2 incidents reported, it is known the majority of them affected only one fraction of a course of treatment. This means that corrective action could be taken over the remaining treatment fractions so the incident did not have a significant impact on the patient or the outcome of their treatment. Analysis of the RTE reports demonstrates that generation of error is not confined to one professional group or to any particular point in the pathway. It also indicates that the pattern of errors is replicated across service providers in the UK. Conclusion: Use of the terminology, classification and coding of TSRT, together with implementation of the national voluntary reporting system described within this report, allows clinical departments to compare their local analysis to the national picture. Further opportunities to improve learning from this dataset must be exploited through development of the analysis and development of proactive risk management strategies

  3. Prevalence of myopia amongst patients with refractive error in

    African Journals Online (AJOL)

    User

    retina but rather in front of it. It is the most prevalent eye defect in the world affecting ... school children has been reported as 1.7% in. Agona Swedru ... Technology. Records of all 2,803 patients who received eye care from the five randomly selected private eye care facilities between January 2010 and. December 2010 were ...

  4. Avoiding Errors in the Management of Pediatric Polytrauma Patients.

    Science.gov (United States)

    Chin, Kenneth; Abzug, Joshua; Bae, Donald S; Horn, Bernard D; Herman, Martin; Eberson, Craig P

    2016-01-01

    Management of pediatric polytrauma patients is one of the most difficult challenges for orthopaedic surgeons. Multisystem injuries frequently include complex orthopaedic surgical problems that require intervention. The physiology and anatomy of children and adolescent trauma patients differ from the physiology and anatomy of an adult trauma patient, which alters the types of injuries sustained and the ideal methods for management. Errors of pediatric polytrauma care are included in two broad categories: missed injuries and inadequate fracture treatment. Diagnoses may be missed most frequently because of a surgeon's inability to reliably assess patients who have traumatic brain injuries and painful distracting injuries. Cervical spine injuries are particularly difficult to identify in a child with polytrauma and may have devastating consequences. In children who have multiple injuries, the stabilization of long bone fractures with pediatric fixation techniques, such as elastic nails and other implants, allows for easier care and more rapid mobilization compared with cast treatments. Adolescent polytrauma patients who are approaching skeletal maturity, however, are ideally treated as adults to avoid complications, such as loss of fixation, and to speed rehabilitation.

  5. Errors in patient specimen collection: application of statistical process control.

    Science.gov (United States)

    Dzik, Walter Sunny; Beckman, Neil; Selleng, Kathleen; Heddle, Nancy; Szczepiorkowski, Zbigniew; Wendel, Silvano; Murphy, Michael

    2008-10-01

    Errors in the collection and labeling of blood samples for pretransfusion testing increase the risk of transfusion-associated patient morbidity and mortality. Statistical process control (SPC) is a recognized method to monitor the performance of a critical process. An easy-to-use SPC method was tested to determine its feasibility as a tool for monitoring quality in transfusion medicine. SPC control charts were adapted to a spreadsheet presentation. Data tabulating the frequency of mislabeled and miscollected blood samples from 10 hospitals in five countries from 2004 to 2006 were used to demonstrate the method. Control charts were produced to monitor process stability. The participating hospitals found the SPC spreadsheet very suitable to monitor the performance of the sample labeling and collection and applied SPC charts to suit their specific needs. One hospital monitored subcategories of sample error in detail. A large hospital monitored the number of wrong-blood-in-tube (WBIT) events. Four smaller-sized facilities, each following the same policy for sample collection, combined their data on WBIT samples into a single control chart. One hospital used the control chart to monitor the effect of an educational intervention. A simple SPC method is described that can monitor the process of sample collection and labeling in any hospital. SPC could be applied to other critical steps in the transfusion processes as a tool for biovigilance and could be used to develop regional or national performance standards for pretransfusion sample collection. A link is provided to download the spreadsheet for free.

  6. Identification errors in the blood transfusion laboratory: a still relevant issue for patient safety.

    Science.gov (United States)

    Lippi, Giuseppe; Plebani, Mario

    2011-04-01

    Remarkable technological advances and increased awareness have both contributed to decrease substantially the uncertainty of the analytical phase, so that the manually intensive preanalytical activities currently represent the leading sources of errors in laboratory and transfusion medicine. Among preanalytical errors, misidentification and mistransfusion are still regarded as a considerable problem, posing serious risks for patient health and carrying huge expenses for the healthcare system. As such, a reliable policy of risk management should be readily implemented, developing through a multifaceted approach to prevent or limit the adverse outcomes related to transfusion reactions from blood incompatibility. This strategy encompasses root cause analysis, compliance with accreditation requirements, strict adherence to standard operating procedures, guidelines and recommendations for specimen collection, use of positive identification devices, rejection of potentially misidentified specimens, informatics data entry, query host communication, automated systems for patient identification and sample labeling and an adequate and safe environment. Copyright © 2011 Elsevier Ltd. All rights reserved.

  7. Visual memory errors in Parkinson's disease patient with visual hallucinations.

    Science.gov (United States)

    Barnes, J; Boubert, L

    2011-03-01

    The occurrences of visual hallucinations seem to be more prevalent in low light and hallucinators tend to be more prone to false positive type errors in memory tasks. Here we investigated whether the richness of stimuli does indeed affect recognition differently in hallucinating and nonhallucinating participants, and if so whether this difference extends to identifying spatial context. We compared 36 Parkinson's disease (PD) patients with visual hallucinations, 32 Parkinson's patients without hallucinations, and 36 age-matched controls, on a visual memory task where color and black and white pictures were presented at different locations. Participants had to recognize the pictures among distracters along with the location of the stimulus. Findings revealed clear differences in performance between the groups. Both PD groups had impaired recognition compared to the controls, but those with hallucinations were significantly more impaired on black and white than on color stimuli. In addition, the group with hallucinations was significantly impaired compared to the other two groups on spatial memory. We suggest that not only do PD patients have poorer recognition of pictorial stimuli than controls, those who present with visual hallucinations appear to be more heavily reliant on bottom up sensory input and impaired on spatial ability.

  8. Frecuencia de errores de los pacientes con su medicación Frequency of medication errors by patients

    Directory of Open Access Journals (Sweden)

    José Joaquín Mira

    2012-02-01

    Full Text Available OBJETIVO: Analizar la frecuencia de errores de medicación que son cometidos e informados por los pacientes. MÉTODOS: Estudio descriptivo basado en encuestas telefónicas a una muestra aleatoria de pacientes adultos del nivel primario de salud del sistema público español. Respondieron un total de 1 247 pacientes (tasa de respuesta, 75%. El 63% eran mujeres y 29% eran mayores de 70 años. RESULTADOS: Mientras 37 pacientes (3%, IC 95%: 2-4 sufrieron complicaciones asociadas a la medicación en el curso del tratamiento, 241 (19,4%, IC 95%: 17-21 informaron haber cometido algún error con la medicación. Un menor tiempo de consulta (P OBJECTIVE: Analyze the frequency of medication errors committed and reported by patients. METHODS: Descriptive study based on a telephone survey of a random sample of adult patients from the primary care level of the Spanish public health care system. A total of 1 247 patients responded (75% response rate; 63% were women and 29% were older than 70 years. RESULTS: While 37 patients (3%, 95% CI: 2-4 experienced complications associated with medication in the course of treatment, 241 (19.4%, 95% CI: 17-21 reported having made some mistake with their medication. A shorter consultation time (P < 0.01 and a worse assessment of the information provided by the physician (P < 0.01 were associated with the fact that during pharmacy dispensing the patient was told that the prescribed treatment was not appropriate. CONCLUSIONS: In addition to the known risks of an adverse event due to a health intervention resulting from a system or practitioner error, there are risks associated with patient errors in the self-administration of medication. Patients who were unsatisfied with the information provided by the physician reported a greater number of errors.

  9. A systematic review of patient medication error on self-administering medication at home.

    Science.gov (United States)

    Mira, José Joaquín; Lorenzo, Susana; Guilabert, Mercedes; Navarro, Isabel; Pérez-Jover, Virtudes

    2015-06-01

    Medication errors have been analyzed as a health professionals' responsibility (due to mistakes in prescription, preparation or dispensing). However, sometimes, patients themselves (or their caregivers) make mistakes in the administration of the medication. The epidemiology of patient medication errors (PEs) has been scarcely reviewed in spite of its impact on people, on therapeutic effectiveness and on incremental cost for the health systems. This study reviews and describes the methodological approaches and results of published studies on the frequency, causes and consequences of medication errors committed by patients at home. A review of research articles published between 1990 and 2014 was carried out using MEDLINE, Web-of-Knowledge, Scopus, Tripdatabase and Index Medicus. The frequency of PE was situated between 19 and 59%. The elderly and the preschooler population constituted a higher number of mistakes than others. The most common were: incorrect dosage, forgetting, mixing up medications, failing to recall indications and taking out-of-date or inappropriately stored drugs. The majority of these mistakes have no negative consequences. Health literacy, information and communication and complexity of use of dispensing devices were identified as causes of PEs. Apps and other new technologies offer several opportunities for improving drug safety.

  10. A Study of Trial and Error Learning in Technology, Engineering, and Design Education

    Science.gov (United States)

    Franzen, Marissa Marie Sloan

    2016-01-01

    The purpose of this research study was to determine if trial and error learning was an effective, practical, and efficient learning method for Technology, Engineering, and Design Education students at the post-secondary level. A mixed methods explanatory research design was used to measure the viability of the learning source. The study sample was…

  11. The impact of health information technology on patient safety.

    Science.gov (United States)

    Alotaibi, Yasser K; Federico, Frank

    2017-12-01

    Since the original Institute of Medicine (IOM) report was published there has been an accelerated development and adoption of health information technology with varying degrees of evidence about the impact of health information technology on patient safety.  This article is intended to review the current available scientific evidence on the impact of different health information technologies on improving patient safety outcomes. We conclude that health information technology improves patient's safety by reducing medication errors, reducing adverse drug reactions, and improving compliance to practice guidelines. There should be no doubt that health information technology is an important tool for improving healthcare quality and safety. Healthcare organizations need to be selective in which technology to invest in, as literature shows that some technologies have limited evidence in improving patient safety outcomes.

  12. Patient safety in the clinical laboratory: a longitudinal analysis of specimen identification errors.

    Science.gov (United States)

    Wagar, Elizabeth A; Tamashiro, Lorraine; Yasin, Bushra; Hilborne, Lee; Bruckner, David A

    2006-11-01

    Patient safety is an increasingly visible and important mission for clinical laboratories. Attention to improving processes related to patient identification and specimen labeling is being paid by accreditation and regulatory organizations because errors in these areas that jeopardize patient safety are common and avoidable through improvement in the total testing process. To assess patient identification and specimen labeling improvement after multiple implementation projects using longitudinal statistical tools. Specimen errors were categorized by a multidisciplinary health care team. Patient identification errors were grouped into 3 categories: (1) specimen/requisition mismatch, (2) unlabeled specimens, and (3) mislabeled specimens. Specimens with these types of identification errors were compared preimplementation and postimplementation for 3 patient safety projects: (1) reorganization of phlebotomy (4 months); (2) introduction of an electronic event reporting system (10 months); and (3) activation of an automated processing system (14 months) for a 24-month period, using trend analysis and Student t test statistics. Of 16,632 total specimen errors, mislabeled specimens, requisition mismatches, and unlabeled specimens represented 1.0%, 6.3%, and 4.6% of errors, respectively. Student t test showed a significant decrease in the most serious error, mislabeled specimens (P patient safety projects. Trend analysis demonstrated decreases in all 3 error types for 26 months. Applying performance-improvement strategies that focus longitudinally on specimen labeling errors can significantly reduce errors, therefore improving patient safety. This is an important area in which laboratory professionals, working in interdisciplinary teams, can improve safety and outcomes of care.

  13. Antiretroviral medication prescribing errors are common with hospitalization of HIV-infected patients.

    Science.gov (United States)

    Commers, Tessa; Swindells, Susan; Sayles, Harlan; Gross, Alan E; Devetten, Marcel; Sandkovsky, Uriel

    2014-01-01

    Errors in prescribing antiretroviral therapy (ART) often occur with the hospitalization of HIV-infected patients. The rapid identification and prevention of errors may reduce patient harm and healthcare-associated costs. A retrospective review of hospitalized HIV-infected patients was carried out between 1 January 2009 and 31 December 2011. Errors were documented as omission, underdose, overdose, duplicate therapy, incorrect scheduling and/or incorrect therapy. The time to error correction was recorded. Relative risks (RRs) were computed to evaluate patient characteristics and error rates. A total of 289 medication errors were identified in 146/416 admissions (35%). The most common was drug omission (69%). At an error rate of 31%, nucleoside reverse transcriptase inhibitors were associated with an increased risk of error when compared with protease inhibitors (RR 1.32; 95% CI 1.04-1.69) and co-formulated drugs (RR 1.59; 95% CI 1.19-2.09). Of the errors, 31% were corrected within the first 24 h, but over half (55%) were never remedied. Admissions with an omission error were 7.4 times more likely to have all errors corrected within 24 h than were admissions without an omission. Drug interactions with ART were detected on 51 occasions. For the study population (n = 177), an increased risk of admission error was observed for black (43%) compared with white (28%) individuals (RR 1.53; 95% CI 1.16-2.03) but no significant differences were observed between white patients and other minorities or between men and women. Errors in inpatient ART were common, and the majority were never detected. The most common errors involved omission of medication, and nucleoside reverse transcriptase inhibitors had the highest rate of prescribing error. Interventions to prevent and correct errors are urgently needed.

  14. The Impact of a Patient Safety Program on Medical Error Reporting

    Science.gov (United States)

    2005-05-01

    307 The Impact of a Patient Safety Program on Medical Error Reporting Donald R. Woolever Abstract Background: In response to the occurrence of...a sentinel event—a medical error with serious consequences—Eglin U.S. Air Force (USAF) Regional Hospital developed and implemented a patient safety...communication, teamwork, and reporting. Objective: To determine the impact of a patient safety program on patterns of medical error reporting. Methods: This

  15. Evaluation of positioning errors of the patient using cone beam CT megavoltage

    International Nuclear Information System (INIS)

    Garcia Ruiz-Zorrilla, J.; Fernandez Leton, J. P.; Zucca Aparicio, D.; Perez Moreno, J. M.; Minambres Moro, A.

    2013-01-01

    Image-guided radiation therapy allows you to assess and fix the positioning of the patient in the treatment unit, thus reducing the uncertainties due to the positioning of the patient. This work assesses errors systematic and errors of randomness from the corrections made to a series of patients of different diseases through a protocol off line of cone beam CT (CBCT) megavoltage. (Author)

  16. Brain State Before Error Making in Young Patients With Mild Spastic Cerebral Palsy.

    Science.gov (United States)

    Hakkarainen, Elina; Pirilä, Silja; Kaartinen, Jukka; van der Meere, Jaap J

    2015-10-01

    In the present experiment, children with mild spastic cerebral palsy and a control group carried out a memory recognition task. The key question was if errors of the patient group are foreshadowed by attention lapses, by weak motor preparation, or by both. Reaction times together with event-related potentials associated with motor preparation (frontal late contingent negative variation), attention (parietal P300), and response evaluation (parietal error-preceding positivity) were investigated in instances where 3 subsequent correct trials preceded an error. The findings indicated that error responses of the patient group are foreshadowed by weak motor preparation in correct trials directly preceding an error. © The Author(s) 2015.

  17. Error or "act of God"? A study of patients' and operating room team members' perceptions of error definition, reporting, and disclosure.

    Science.gov (United States)

    Espin, Sherry; Levinson, Wendy; Regehr, Glenn; Baker, G Ross; Lingard, Lorelei

    2006-01-01

    Calls abound for a culture change in health care to improve patient safety. However, effective change cannot proceed without a clear understanding of perceptions and beliefs about error. In this study, we describe and compare operative team members' and patients' perceptions of error, reporting of error, and disclosure of error. Thirty-nine interviews of team members (9 surgeons, 9 nurses, 10 anesthesiologists) and patients (11) were conducted at 2 teaching hospitals using 4 scenarios as prompts. Transcribed responses to open questions were analyzed by 2 researchers for recurrent themes using the grounded-theory method. Yes/no answers were compared across groups using chi-square analyses. Team members and patients agreed on what constitutes an error. Deviation from standards and negative outcome were emphasized as definitive features. Patients and nurse professionals differed significantly in their perception of whether errors should be reported. Nurses were willing to report only events within their disciplinary scope of practice. Although most patients strongly advocated full disclosure of errors (what happened and how), team members preferred to disclose only what happened. When patients did support partial disclosure, their rationales varied from that of team members. Both operative teams and patients define error in terms of breaking the rules and the concept of "no harm no foul." These concepts pose challenges for treating errors as system failures. A strong culture of individualism pervades nurses' perception of error reporting, suggesting that interventions are needed to foster collective responsibility and a constructive approach to error identification.

  18. The impact of health information technology on patient safety

    Directory of Open Access Journals (Sweden)

    Yasser K. Alotaibi

    2017-12-01

    Full Text Available Since the original Institute of Medicine (IOM report was published there has been an accelerated development and adoption of health information technology with varying degrees of evidence about the impact of health information technology on patient safety. This article is intended to review the current available scientific evidence on the impact of different health information technologies on improving patient safety outcomes. We conclude that health information technology improves patient’s safety by reducing medication errors, reducing adverse drug reactions, and improving compliance to practice guidelines. There should be no doubt that health information technology is an important tool for improving healthcare quality and safety. Healthcare organizations need to be selective in which technology to invest in, as literature shows that some technologies have limited evidence in improving patient safety outcomes.

  19. Medication Errors in Patients with Enteral Feeding Tubes in the Intensive Care Unit.

    Science.gov (United States)

    Sohrevardi, Seyed Mojtaba; Jarahzadeh, Mohammad Hossein; Mirzaei, Ehsan; Mirjalili, Mahtabalsadat; Tafti, Arefeh Dehghani; Heydari, Behrooz

    2017-01-01

    Most patients admitted to Intensive Care Units (ICU) have problems in using oral medication or ingesting solid forms of drugs. Selecting the most suitable dosage form in such patients is a challenge. The current study was conducted to assess the frequency and types of errors of oral medication administration in patients with enteral feeding tubes or suffering swallowing problems. A cross-sectional study was performed in the ICU of Shahid Sadoughi Hospital, Yazd, Iran. Patients were assessed for the incidence and types of medication errors occurring in the process of preparation and administration of oral medicines. Ninety-four patients were involved in this study and 10,250 administrations were observed. Totally, 4753 errors occurred among the studied patients. The most commonly used drugs were pantoprazole tablet, piracetam syrup, and losartan tablet. A total of 128 different types of drugs and nine different oral pharmaceutical preparations were prescribed for the patients. Forty-one (35.34%) out of 116 different solid drugs (except effervescent tablets and powders) could be substituted by liquid or injectable forms. The most common error was the wrong time of administration. Errors of wrong dose preparation and administration accounted for 24.04% and 25.31% of all errors, respectively. In this study, at least three-fourth of the patients experienced medication errors. The occurrence of these errors can greatly impair the quality of the patients' pharmacotherapy, and more attention should be paid to this issue.

  20. Nurses' Behaviors and Visual Scanning Patterns May Reduce Patient Identification Errors

    Science.gov (United States)

    Marquard, Jenna L.; Henneman, Philip L.; He, Ze; Jo, Junghee; Fisher, Donald L.; Henneman, Elizabeth A.

    2011-01-01

    Patient identification (ID) errors occurring during the medication administration process can be fatal. The aim of this study is to determine whether differences in nurses' behaviors and visual scanning patterns during the medication administration process influence their capacities to identify patient ID errors. Nurse participants (n = 20)…

  1. Transparency When Things Go Wrong: Physician Attitudes About Reporting Medical Errors to Patients, Peers, and Institutions.

    Science.gov (United States)

    Bell, Sigall K; White, Andrew A; Yi, Jean C; Yi-Frazier, Joyce P; Gallagher, Thomas H

    2017-12-01

    Transparent communication after medical error includes disclosing the mistake to the patient, discussing the event with colleagues, and reporting to the institution. Little is known about whether attitudes about these transparency practices are related. Understanding these relationships could inform educational and organizational strategies to promote transparency. We analyzed responses of 3038 US and Canadian physicians to a medical error communication survey. We used bivariate correlations, principal components analysis, and linear regression to determine whether and how physician attitudes about transparent communication with patients, peers, and the institution after error were related. Physician attitudes about disclosing errors to patients, peers, and institutions were correlated (all P's transparent communication with patients and peers/institution included female sex, US (vs Canadian) doctors, academic (vs private) practice, the belief that disclosure decreased likelihood of litigation, and the belief that system changes occur after error reporting. In addition, younger physicians, surgeons, and those with previous experience disclosing a serious error were more likely to agree with disclosure to patients. In comparison, doctors who believed that disclosure would decrease patient trust were less likely to agree with error disclosure to patients. Previous disclosure education was associated with attitudes supporting greater transparency with peers/institution. Physician attitudes about discussing errors with patients, colleagues, and institutions are related. Several predictors of transparency affect all 3 practices and are potentially modifiable by educational and institutional strategies.

  2. Relating faults in diagnostic reasoning with diagnostic errors and patient harm.

    NARCIS (Netherlands)

    Zwaan, L.; Thijs, A.; Wagner, C.; Wal, G. van der; Timmermans, D.R.M.

    2012-01-01

    Purpose: The relationship between faults in diagnostic reasoning, diagnostic errors, and patient harm has hardly been studied. This study examined suboptimal cognitive acts (SCAs; i.e., faults in diagnostic reasoning), related them to the occurrence of diagnostic errors and patient harm, and studied

  3. Evaluation of rotational set-up errors in patients with thoracic neoplasms

    International Nuclear Information System (INIS)

    Wang Yanyang; Fu Xiaolong; Xia Bing; Fan Min; Yang Huanjun; Ren Jun; Xu Zhiyong; Jiang Guoliang

    2010-01-01

    Objective: To assess the rotational set-up errors in patients with thoracic neoplasms. Methods: 224 kilovoltage cone-beam computed tomography (KVCBCT) scans from 20 thoracic tumor patients were evaluated retrospectively. All these patients were involved in the research of 'Evaluation of the residual set-up error for online kilovoltage cone-beam CT guided thoracic tumor radiation'. Rotational set-up errors, including pitch, roll and yaw, were calculated by 'aligning the KVCBCT with the planning CT, using the semi-automatic alignment method. Results: The average rotational set-up errors were -0.28 degree ±1.52 degree, 0.21 degree ± 0.91 degree and 0.27 degree ± 0.78 degree in the left-fight, superior-inferior and anterior-posterior axis, respectively. The maximal rotational errors of pitch, roll and yaw were 3.5 degree, 2.7 degree and 2.2 degree, respectively. After correction for translational set-up errors, no statistically significant changes in rotational error were observed. Conclusions: The rotational set-up errors in patients with thoracic neoplasms were all small in magnitude. Rotational errors may not change after the correction for translational set-up errors alone, which should be evaluated in a larger sample future. (authors)

  4. Reducing patient identification errors related to glucose point-of-care testing

    Directory of Open Access Journals (Sweden)

    Gaurav Alreja

    2011-01-01

    Full Text Available Background: Patient identification (ID errors in point-of-care testing (POCT can cause test results to be transferred to the wrong patient′s chart or prevent results from being transmitted and reported. Despite the implementation of patient barcoding and ongoing operator training at our institution, patient ID errors still occur with glucose POCT. The aim of this study was to develop a solution to reduce identification errors with POCT. Materials and Methods: Glucose POCT was performed by approximately 2,400 clinical operators throughout our health system. Patients are identified by scanning in wristband barcodes or by manual data entry using portable glucose meters. Meters are docked to upload data to a database server which then transmits data to any medical record matching the financial number of the test result. With a new model, meters connect to an interface manager where the patient ID (a nine-digit account number is checked against patient registration data from admission, discharge, and transfer (ADT feeds and only matched results are transferred to the patient′s electronic medical record. With the new process, the patient ID is checked prior to testing, and testing is prevented until ID errors are resolved. Results: When averaged over a period of a month, ID errors were reduced to 3 errors/month (0.015% in comparison with 61.5 errors/month (0.319% before implementing the new meters. Conclusion: Patient ID errors may occur with glucose POCT despite patient barcoding. The verification of patient identification should ideally take place at the bedside before testing occurs so that the errors can be addressed in real time. The introduction of an ADT feed directly to glucose meters reduced patient ID errors in POCT.

  5. The impact of treatment complexity and computer-control delivery technology on treatment delivery errors

    International Nuclear Information System (INIS)

    Fraass, Benedick A.; Lash, Kathy L.; Matrone, Gwynne M.; Volkman, Susan K.; McShan, Daniel L.; Kessler, Marc L.; Lichter, Allen S.

    1998-01-01

    Purpose: To analyze treatment delivery errors for three-dimensional (3D) conformal therapy performed at various levels of treatment delivery automation and complexity, ranging from manual field setup to virtually complete computer-controlled treatment delivery using a computer-controlled conformal radiotherapy system (CCRS). Methods and Materials: All treatment delivery errors which occurred in our department during a 15-month period were analyzed. Approximately 34,000 treatment sessions (114,000 individual treatment segments [ports]) on four treatment machines were studied. All treatment delivery errors logged by treatment therapists or quality assurance reviews (152 in all) were analyzed. Machines 'M1' and 'M2' were operated in a standard manual setup mode, with no record and verify system (R/V). MLC machines 'M3' and 'M4' treated patients under the control of the CCRS system, which (1) downloads the treatment delivery plan from the planning system; (2) performs some (or all) of the machine set up and treatment delivery for each field; (3) monitors treatment delivery; (4) records all treatment parameters; and (5) notes exceptions to the electronically-prescribed plan. Complete external computer control is not available on M3; therefore, it uses as many CCRS features as possible, while M4 operates completely under CCRS control and performs semi-automated and automated multi-segment intensity modulated treatments. Analysis of treatment complexity was based on numbers of fields, individual segments, nonaxial and noncoplanar plans, multisegment intensity modulation, and pseudoisocentric treatments studied for a 6-month period (505 patients) concurrent with the period in which the delivery errors were obtained. Treatment delivery time was obtained from the computerized scheduling system (for manual treatments) or from CCRS system logs. Treatment therapists rotate among the machines; therefore, this analysis does not depend on fixed therapist staff on particular

  6. Evaluation of positioning errors of the patient using cone beam CT megavoltage; Evaluacion de errores de posicionamiento del paciente mediante Cone Beam CT de megavoltaje

    Energy Technology Data Exchange (ETDEWEB)

    Garcia Ruiz-Zorrilla, J.; Fernandez Leton, J. P.; Zucca Aparicio, D.; Perez Moreno, J. M.; Minambres Moro, A.

    2013-07-01

    Image-guided radiation therapy allows you to assess and fix the positioning of the patient in the treatment unit, thus reducing the uncertainties due to the positioning of the patient. This work assesses errors systematic and errors of randomness from the corrections made to a series of patients of different diseases through a protocol off line of cone beam CT (CBCT) megavoltage. (Author)

  7. Responsibility for reporting patient death due to hospital error in Japan when an error occurred at a referring institution.

    Science.gov (United States)

    Maeda, Shoichi; Starkey, Jay; Kamishiraki, Etsuko; Ikeda, Noriaki

    2013-12-01

    In Japan, physicians are required to report unexpected health care-associated patient deaths to the police. Patients needing to be transferred to another institution often have complex medical problems. If a medical error occurs, it may be either at the final or the referring institution. Some fear that liability will fall on the final institution regardless of where the error occurred or that the referring facility may oppose such reporting, leading to a failure to report to police or to recommend an autopsy. Little is known about the actual opinions of physicians and risk managers in this regard. The authors sent standardised, self-administered questionnaires to all hospitals in Japan that participate in the national general residency program. Most physicians and risk managers in Japan indicated that they would report a patient's death to the police where the patient has been transferred. Of those who indicated they would not report to the police, the majority still indicated they would recommend an autopsy

  8. UNDERSTANDING OR NURSES' REACTIONS TO ERRORS AND USING THIS UNDERSTANDING TO IMPROVE PATIENT SAFETY.

    Science.gov (United States)

    Taifoori, Ladan; Valiee, Sina

    2015-09-01

    The operating room can be home to many different types of nursing errors due to the invasiveness of OR procedures. The nurses' reactions towards errors can be a key factor in patient safety. This article is based on a study, with the aim of investigating nurses' reactions toward nursing errors and the various contributing and resulting factors, conducted at Kurdistan University of Medical Sciences in Sanandaj, Iran in 2014. The goal of the study was to determine how OR nurses' reacted to nursing errors with the goal of having this information used to improve patient safety. Research was conducted as a cross-sectional descriptive study. The participants were all nurses employed in the operating rooms of the teaching hospitals of Kurdistan University of Medical Sciences, which was selected by a consensus method (170 persons). The information was gathered through questionnaires that focused on demographic information, error definition, reasons for error occurrence, and emotional reactions for error occurrence, and emotional reactions toward the errors. 153 questionnaires were completed and analyzed by SPSS software version 16.0. "Not following sterile technique" (82.4 percent) was the most reported nursing error, "tiredness" (92.8 percent) was the most reported reason for the error occurrence, "being upset at having harmed the patient" (85.6 percent) was the most reported emotional reaction after error occurrence", with "decision making for a better approach to tasks the next time" (97.7 percent) as the most common goal and "paying more attention to details" (98 percent) was the most reported planned strategy for future improved outcomes. While healthcare facilities are focused on planning for the prevention and elimination of errors it was shown that nurses can also benefit from support after error occurrence. Their reactions, and coping strategies, need guidance and, with both individual and organizational support, can be a factor in improving patient safety.

  9. A vignette study to examine health care professionals' attitudes towards patient involvement in error prevention.

    Science.gov (United States)

    Schwappach, David L B; Frank, Olga; Davis, Rachel E

    2013-10-01

    Various authorities recommend the participation of patients in promoting patient safety, but little is known about health care professionals' (HCPs') attitudes towards patients' involvement in safety-related behaviours. To investigate how HCPs evaluate patients' behaviours and HCP responses to patient involvement in the behaviour, relative to different aspects of the patient, the involved HCP and the potential error. Cross-sectional fractional factorial survey with seven factors embedded in two error scenarios (missed hand hygiene, medication error). Each survey included two randomized vignettes that described the potential error, a patient's reaction to that error and the HCP response to the patient. Twelve hospitals in Switzerland. A total of 1141 HCPs (response rate 45%). Approval of patients' behaviour, HCP response to the patient, anticipated effects on the patient-HCP relationship, HCPs' support for being asked the question, affective response to the vignettes. Outcomes were measured on 7-point scales. Approval of patients' safety-related interventions was generally high and largely affected by patients' behaviour and correct identification of error. Anticipated effects on the patient-HCP relationship were much less positive, little correlated with approval of patients' behaviour and were mainly determined by the HCP response to intervening patients. HCPs expressed more favourable attitudes towards patients intervening about a medication error than about hand sanitation. This study provides the first insights into predictors of HCPs' attitudes towards patient engagement in safety. Future research is however required to assess the generalizability of the findings into practice before training can be designed to address critical issues. © 2012 John Wiley & Sons Ltd.

  10. Technology-Induced Errors and Adverse Event Reporting in an Organizational Learning Perspective.

    Science.gov (United States)

    Vinther, Line Dausel; Jensen, Christian Møller; Hjelmager, Ditte Meulengracht; Lyhne, Nicoline; Nøhr, Christian

    2017-01-01

    This paper addresses the possibilities of evaluating technology-induced errors, through the utilization of experiences of the Danish adverse event reporting system. The learning loop in the adverse event reporting system is identified and analyzed, to examine which elements can be utilized to evaluate technologies. The empirical data was collected through interviews and a workshop with members of the nursing staff at a nursing home in Aalborg, Denmark. It was found that, the establishment of sustainable feedback learning loops depends on shared visions in the organization and how creating shared visions requires involvement and participation. Secondly, care workers must possess fundamental knowledge about the technologies available to them. Thirdly comprehensive classification of adverse events should be established to allow for a systematic and goal directed feed-back process.

  11. Impact of energy technology patents in China: Evidence from a panel cointegration and error correction model

    International Nuclear Information System (INIS)

    Li, Ke; Lin, Boqiang

    2016-01-01

    Enhancing energy technology innovation performance, which is widely measured by energy technology patents through energy technology research and development (R&D) activities, is a fundamental way to implement energy conservation and emission abatement. This study analyzes the effects of R&D investment activities, economic growth, and energy price on energy technology patents in 30 provinces of China over the period 1999–2013. Several unit root tests indicate that all the above variables are generated by panel unit root processes, and a panel cointegration model is confirmed among the variables. In order to ensure the consistency of the estimators, the Fully-Modified OLS (FMOLS) method is adopted, and the results indicate that R&D investment activities and economic growth have positive effects on energy technology patents while energy price has a negative effect. However, the panel error correction models indicate that the cointegration relationship helps to promote economic growth, but it reduces R&D investment and energy price in the short term. Therefore, market-oriented measures including financial support and technical transformation policies for the development of low-carbon energy technologies, an effective energy price mechanism, especially the targeted fossil-fuel subsidies and their die away mode are vital in promoting China's energy technology innovation. - Highlights: • Energy technology patents in China are analyzed. • Relationship between energy patents and funds for R&D activities are analyzed. • China's energy price system hinders energy technology innovation. • Some important implications for China's energy technology policy are discussed. • A panel cointegration model with FMOLS estimator is used.

  12. Medical errors in hospitalized pediatric trauma patients with chronic health conditions

    Directory of Open Access Journals (Sweden)

    Xiaotong Liu

    2014-01-01

    Full Text Available Objective: This study compares medical errors in pediatric trauma patients with and without chronic conditions. Methods: The 2009 Kids’ Inpatient Database, which included 123,303 trauma discharges, was analyzed. Medical errors were identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. The medical error rates per 100 discharges and per 1000 hospital days were calculated and compared between inpatients with and without chronic conditions. Results: Pediatric trauma patients with chronic conditions experienced a higher medical error rate compared with patients without chronic conditions: 4.04 (95% confidence interval: 3.75–4.33 versus 1.07 (95% confidence interval: 0.98–1.16 per 100 discharges. The rate of medical error differed by type of chronic condition. After controlling for confounding factors, the presence of a chronic condition increased the adjusted odds ratio of medical error by 37% if one chronic condition existed (adjusted odds ratio: 1.37, 95% confidence interval: 1.21–1.5, and 69% if more than one chronic condition existed (adjusted odds ratio: 1.69, 95% confidence interval: 1.48–1.53. In the adjusted model, length of stay had the strongest association with medical error, but the adjusted odds ratio for chronic conditions and medical error remained significantly elevated even when accounting for the length of stay, suggesting that medical complexity has a role in medical error. Higher adjusted odds ratios were seen in other subgroups. Conclusion: Chronic conditions are associated with significantly higher rate of medical errors in pediatric trauma patients. Future research should evaluate interventions or guidelines for reducing the risk of medical errors in pediatric trauma patients with chronic conditions.

  13. Safety coaches in radiology: decreasing human error and minimizing patient harm

    Energy Technology Data Exchange (ETDEWEB)

    Dickerson, Julie M.; Adams, Janet M. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, MLC 5031, Cincinnati, OH (United States); Koch, Bernadette L.; Donnelly, Lane F. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, MLC 5031, Cincinnati, OH (United States); Cincinnati Children' s Hospital Medical Center, Department of Pediatrics, Cincinnati, OH (United States); Goodfriend, Martha A. [Cincinnati Children' s Hospital Medical Center, Department of Quality Improvement, Cincinnati, OH (United States)

    2010-09-15

    Successful programs to improve patient safety require a component aimed at improving safety culture and environment, resulting in a reduced number of human errors that could lead to patient harm. Safety coaching provides peer accountability. It involves observing for safety behaviors and use of error prevention techniques and provides immediate feedback. For more than a decade, behavior-based safety coaching has been a successful strategy for reducing error within the context of occupational safety in industry. We describe the use of safety coaches in radiology. Safety coaches are an important component of our comprehensive patient safety program. (orig.)

  14. Safety coaches in radiology: decreasing human error and minimizing patient harm

    International Nuclear Information System (INIS)

    Dickerson, Julie M.; Adams, Janet M.; Koch, Bernadette L.; Donnelly, Lane F.; Goodfriend, Martha A.

    2010-01-01

    Successful programs to improve patient safety require a component aimed at improving safety culture and environment, resulting in a reduced number of human errors that could lead to patient harm. Safety coaching provides peer accountability. It involves observing for safety behaviors and use of error prevention techniques and provides immediate feedback. For more than a decade, behavior-based safety coaching has been a successful strategy for reducing error within the context of occupational safety in industry. We describe the use of safety coaches in radiology. Safety coaches are an important component of our comprehensive patient safety program. (orig.)

  15. Safety coaches in radiology: decreasing human error and minimizing patient harm.

    Science.gov (United States)

    Dickerson, Julie M; Koch, Bernadette L; Adams, Janet M; Goodfriend, Martha A; Donnelly, Lane F

    2010-09-01

    Successful programs to improve patient safety require a component aimed at improving safety culture and environment, resulting in a reduced number of human errors that could lead to patient harm. Safety coaching provides peer accountability. It involves observing for safety behaviors and use of error prevention techniques and provides immediate feedback. For more than a decade, behavior-based safety coaching has been a successful strategy for reducing error within the context of occupational safety in industry. We describe the use of safety coaches in radiology. Safety coaches are an important component of our comprehensive patient safety program.

  16. Statistical evaluation of major human errors during the development of new technological systems

    International Nuclear Information System (INIS)

    Campbell, G; Ott, K.O.

    1979-01-01

    Statistical procedures are presented to evaluate major human errors during the development of a new system, errors that have led or can lead to accidents or major failures. The first procedure aims at estimating the average residual occurrence rate for s or major failures after several have occurred. The procedure is solely based on the historical record. Certain idealizations are introduced that allow the application of a sound statistical evaluation procedure. These idealizations are practically realized to a sufficient degree such that the proposed estimation procedure yields meaningful results, even for situations with a sparse data base, represented by very few accidents. Under the assumption that the possible human-error-related failure times have exponential distributions, the statistical technique of isotonic regression is proposed to estimate the failure rates due to human design error at the failure times of the system. The last value in the sequence of estimates gives the residual accident chance. In addition, theactual situation is tested against the hypothesis that the failure rate of the system remains constant over time. This test determines the chance for a decreasing failure rate being incidental, rather than an indication of an actual learning process. Both techniques can be applied not merely to a single system but to an entire series of similar systems that a technology would generate, enabling the assessment of technological improvement. For the purpose of illustration, the nuclear decay of isotopes was chosen as an example, since the assumptions of the model are rigorously satisfied in this case. This application shows satisfactory agreement of the estimated and actual failure rates (which are exactly known in this example), although the estimation was deliberately based on a sparse historical record

  17. Effect of patient setup errors on simultaneously integrated boost head and neck IMRT treatment plans

    International Nuclear Information System (INIS)

    Siebers, Jeffrey V.; Keall, Paul J.; Wu Qiuwen; Williamson, Jeffrey F.; Schmidt-Ullrich, Rupert K.

    2005-01-01

    Purpose: The purpose of this study is to determine dose delivery errors that could result from random and systematic setup errors for head-and-neck patients treated using the simultaneous integrated boost (SIB)-intensity-modulated radiation therapy (IMRT) technique. Methods and Materials: Twenty-four patients who participated in an intramural Phase I/II parotid-sparing IMRT dose-escalation protocol using the SIB treatment technique had their dose distributions reevaluated to assess the impact of random and systematic setup errors. The dosimetric effect of random setup error was simulated by convolving the two-dimensional fluence distribution of each beam with the random setup error probability density distribution. Random setup errors of σ = 1, 3, and 5 mm were simulated. Systematic setup errors were simulated by randomly shifting the patient isocenter along each of the three Cartesian axes, with each shift selected from a normal distribution. Systematic setup error distributions with Σ = 1.5 and 3.0 mm along each axis were simulated. Combined systematic and random setup errors were simulated for σ = Σ = 1.5 and 3.0 mm along each axis. For each dose calculation, the gross tumor volume (GTV) received by 98% of the volume (D 98 ), clinical target volume (CTV) D 90 , nodes D 90 , cord D 2 , and parotid D 50 and parotid mean dose were evaluated with respect to the plan used for treatment for the structure dose and for an effective planning target volume (PTV) with a 3-mm margin. Results: Simultaneous integrated boost-IMRT head-and-neck treatment plans were found to be less sensitive to random setup errors than to systematic setup errors. For random-only errors, errors exceeded 3% only when the random setup error σ exceeded 3 mm. Simulated systematic setup errors with Σ = 1.5 mm resulted in approximately 10% of plan having more than a 3% dose error, whereas a Σ = 3.0 mm resulted in half of the plans having more than a 3% dose error and 28% with a 5% dose error

  18. Information technology for patient empowerment in healthcare

    CERN Document Server

    Grando, Maria Adela; Bates, David

    2015-01-01

    The authors explore novel information-based mechanisms that are changing the way patients are involved in their own health care. The book covers models, frameworks and technologies to improve patient-to-provider communication, patient interaction with information technologies, patient education and involvement in health care decision processes, and patient access, understanding and control over their clinical data.

  19. Error reduction in health care: a systems approach to improving patient safety

    National Research Council Canada - National Science Library

    Spath, Patrice

    2011-01-01

    .... The book pinpoints how to reduce and eliminate medical mistakes that threaten the health and safety of patients and teaches how to identify the root cause of medical errors, implement strategies...

  20. Successful remediation of patient safety incidents: a tale of two medication errors.

    Science.gov (United States)

    Helmchen, Lorens A; Richards, Michael R; McDonald, Timothy B

    2011-01-01

    As patient safety acquires strategic importance for all stakeholders in the health care delivery chain, one promising mechanism centers on the proactive disclosure of medical errors to patients. Yet, disclosure and apology alone will not be effective in fully addressing patients' concerns after an adverse event unless they are paired with a remediation component. The purpose of this study was to identify key features of successful remediation efforts that accompany the proactive disclosure of medical errors to patients. We describe and contrast two recent and very similar cases of preventable medical error involving inappropriate medication at a large tertiary-care academic medical center in the Midwestern United States. Despite their similarity, the two medical errors led to very different health outcomes and remediation trajectories for the injured patients. Although one error causing no permanent harm was mismanaged to the lasting dissatisfaction of the patient, the other resulted in the death of the patient but was remediated to the point of allowing the family to come to terms with the loss and even restored a modicum of trust in the providers' sincerity. To maximize the opportunities for successful remediation, as soon as possible after the incident, providers should pledge to injured patients and their relatives that they will assist and accompany them in their recovery as long as necessary and then follow through on their pledge. As the two case studies show, it takes training and vigilance to ensure adherence to these principles and reach an optimal outcome for patients and their relatives.

  1. Patients' knowledge and perceived reactions to medical errors in a ...

    African Journals Online (AJOL)

    EB

    2013-09-03

    Sep 3, 2013 ... concern is growing in response, there is need to report social and behavioural context of the problem in Nigeria. Objective: To examine .... advertising by law firms and if there is an explicit ... sign of respect for the patient's autonomy as dictated ... conditions, and 25.5% would not recommend the hospital ...

  2. The dose distribution and DVH change analysis wing to effect of the patient setup error

    International Nuclear Information System (INIS)

    Kim, Kyung Tae; Ju, Sang Gyu; Ahn, Jae Hong; Park, Young Hwan

    2004-01-01

    The setup error due to the patient and the staff from radiation treatment as the reason which is important the treatment record could be decided is a possibility of effect. The SET-UP ERROR of the patient analyzes the effect of dose distribution and DVH from radiation treatment of the patient. This test uses human phantom and when C-T scan doing, It rotated the Left direction of the human phantom and it made SET-UP ERROR, Standard plan and 3 mm, 5 mm, 7 mm, 10 mm, 15 mm, 20 mm with to distinguish, it made the C-T scan error. With the result, The SET-UP ERROR got each C-T image Using RTP equipment It used the plan which is used generally from clinical - Box plan, 3 Dimension plan( identical angle 5beam plan) Also, ( CTV+1cm margin, CTV+0.5cm margin, CTV+0.3,cm margin = PTV) it distinguished the standard plan and each set-up error plan and the plan used a dose distribution and the DVH and it analyzed. The Box 4 the plan and 3 Dimension plan which it bites it got similar an dose distribution and DVH in 3 mm, 5 mm From rotation error and Rectilinear movement (0%-2%). Rotation error and rectilinear error 7 mm, 10 mm, 15 mm, 20 mm appeared effect it will go mad to a enough change in treatment (2%-11%) The diminishes the effect of the SET-UP ERROR must reduce move with tension of the patient Also, we are important accessory development and the supply that it reducing of reproducibility and the move.

  3. A Technological Innovation to Reduce Prescribing Errors Based on Implementation Intentions: The Acceptability and Feasibility of MyPrescribe.

    Science.gov (United States)

    Keyworth, Chris; Hart, Jo; Thoong, Hong; Ferguson, Jane; Tully, Mary

    2017-08-01

    "If-Then" plans for patient management. Technology, as opposed to other methods of learning (eg, traditional "paper based" learning), was seen as a positive advancement for continued learning. MyPrescribe was perceived as an acceptable and feasible learning tool for changing prescribing practices, with participants suggesting that it would make an important addition to medical prescribers' training in reflective practice. MyPrescribe is a novel theory-based technological innovation that provides the platform for doctors to create personalized implementation intentions. Applying the COM-B model allows for a more detailed understanding of the perceived mechanisms behind prescribing practices and the ways in which interventions aimed at changing professional practice can be implemented. ©Chris Keyworth, Jo Hart, Hong Thoong, Jane Ferguson, Mary Tully. Originally published in JMIR Human Factors (http://humanfactors.jmir.org), 01.08.2017.

  4. Medical error disclosure and patient safety: legal aspects

    Directory of Open Access Journals (Sweden)

    Olivier Guillod

    2013-12-01

    Full Text Available Reducing the number of preventable adverse events has become a public health issue. The paper discusses in which ways the law can contribute to that goal, especially by encouraging a culture of safety among healthcare professionals. It assesses the need or the usefulness to pass so-called disclosure laws and apology laws, to adopt mandatory but strictly confidential Critical Incidents Reporting Systems in hospitals, to change the fault-based system of medical liability or to amend the rules on criminal liability. The paper eventually calls for adding the law to the present agenda of patient safety.

  5. The alarming reality of medication error: a patient case and review of Pennsylvania and National data.

    Science.gov (United States)

    da Silva, Brianna A; Krishnamurthy, Mahesh

    2016-01-01

    A 71-year-old female accidentally received thiothixene (Navane), an antipsychotic, instead of her anti-hypertensive medication amlodipine (Norvasc) for 3 months. She sustained physical and psychological harm including ambulatory dysfunction, tremors, mood swings, and personality changes. Despite the many opportunities for intervention, multiple health care providers overlooked her symptoms. Errors occurred at multiple care levels, including prescribing, initial pharmacy dispensation, hospitalization, and subsequent outpatient follow-up. This exemplifies the Swiss Cheese Model of how errors can occur within a system. Adverse drug events (ADEs) account for more than 3.5 million physician office visits and 1 million emergency department visits each year. It is believed that preventable medication errors impact more than 7 million patients and cost almost $21 billion annually across all care settings. About 30% of hospitalized patients have at least one discrepancy on discharge medication reconciliation. Medication errors and ADEs are an underreported burden that adversely affects patients, providers, and the economy. Medication reconciliation including an 'indication review' for each prescription is an important aspect of patient safety. The decreasing frequency of pill bottle reviews, suboptimal patient education, and poor communication between healthcare providers are factors that threaten patient safety. Medication error and ADEs cost billions of health care dollars and are detrimental to the provider-patient relationship.

  6. The alarming reality of medication error: a patient case and review of Pennsylvania and National data

    Directory of Open Access Journals (Sweden)

    Brianna A. da Silva

    2016-09-01

    Full Text Available Case description: A 71-year-old female accidentally received thiothixene (Navane, an antipsychotic, instead of her anti-hypertensive medication amlodipine (Norvasc for 3 months. She sustained physical and psychological harm including ambulatory dysfunction, tremors, mood swings, and personality changes. Despite the many opportunities for intervention, multiple health care providers overlooked her symptoms. Discussion: Errors occurred at multiple care levels, including prescribing, initial pharmacy dispensation, hospitalization, and subsequent outpatient follow-up. This exemplifies the Swiss Cheese Model of how errors can occur within a system. Adverse drug events (ADEs account for more than 3.5 million physician office visits and 1 million emergency department visits each year. It is believed that preventable medication errors impact more than 7 million patients and cost almost $21 billion annually across all care settings. About 30% of hospitalized patients have at least one discrepancy on discharge medication reconciliation. Medication errors and ADEs are an underreported burden that adversely affects patients, providers, and the economy. Conclusion: Medication reconciliation including an ‘indication review’ for each prescription is an important aspect of patient safety. The decreasing frequency of pill bottle reviews, suboptimal patient education, and poor communication between healthcare providers are factors that threaten patient safety. Medication error and ADEs cost billions of health care dollars and are detrimental to the provider–patient relationship.

  7. Phonological analysis of substitution errors of patients with apraxia of speech

    Directory of Open Access Journals (Sweden)

    Maysa Luchesi Cera

    Full Text Available Abstract The literature on apraxia of speech describes the types and characteristics of phonological errors in this disorder. In general, phonemes affected by errors are described, but the distinctive features involved have not yet been investigated. Objective: To analyze the features involved in substitution errors produced by Brazilian-Portuguese speakers with apraxia of speech. Methods: 20 adults with apraxia of speech were assessed. Phonological analysis of the distinctive features involved in substitution type errors was carried out using the protocol for the evaluation of verbal and non-verbal apraxia. Results: The most affected features were: voiced, continuant, high, anterior, coronal, posterior. Moreover, the mean of the substitutions of marked to markedness features was statistically greater than the markedness to marked features. Conclusions: This study contributes toward a better characterization of the phonological errors found in apraxia of speech, thereby helping to diagnose communication disorders and the selection criteria of phonemes for rehabilitation in these patients.

  8. Three-dimensional patient setup errors at different treatment sites measured by the Tomotherapy megavoltage CT

    Energy Technology Data Exchange (ETDEWEB)

    Hui, S.K.; Lusczek, E.; Dusenbery, K. [Univ. of Minnesota Medical School, Minneapolis, MN (United States). Dept. of Therapeutic Radiology - Radiation Oncology; DeFor, T. [Univ. of Minnesota Medical School, Minneapolis, MN (United States). Biostatistics and Informatics Core; Levitt, S. [Univ. of Minnesota Medical School, Minneapolis, MN (United States). Dept. of Therapeutic Radiology - Radiation Oncology; Karolinska Institutet, Stockholm (Sweden). Dept. of Onkol-Patol

    2012-04-15

    Reduction of interfraction setup uncertainty is vital for assuring the accuracy of conformal radiotherapy. We report a systematic study of setup error to assess patients' three-dimensional (3D) localization at various treatment sites. Tomotherapy megavoltage CT (MVCT) images were scanned daily in 259 patients from 2005-2008. We analyzed 6,465 MVCT images to measure setup error for head and neck (H and N), chest/thorax, abdomen, prostate, legs, and total marrow irradiation (TMI). Statistical comparisons of the absolute displacements across sites and time were performed in rotation (R), lateral (x), craniocaudal (y), and vertical (z) directions. The global systematic errors were measured to be less than 3 mm in each direction with increasing order of errors for different sites: H and N, prostate, chest, pelvis, spine, legs, and TMI. The differences in displacements in the x, y, and z directions, and 3D average displacement between treatment sites were significant (p < 0.01). Overall improvement in patient localization with time (after 3-4 treatment fractions) was observed. Large displacement (> 5 mm) was observed in the 75{sup th} percentile of the patient groups for chest, pelvis, legs, and spine in the x and y direction in the second week of the treatment. MVCT imaging is essential for determining 3D setup error and to reduce uncertainty in localization at all anatomical locations. Setup error evaluation should be performed daily for all treatment regions, preferably for all treatment fractions. (orig.)

  9. Reducing wrong patient selection errors: exploring the design space of user interface techniques.

    Science.gov (United States)

    Sopan, Awalin; Plaisant, Catherine; Powsner, Seth; Shneiderman, Ben

    2014-01-01

    Wrong patient selection errors are a major issue for patient safety; from ordering medication to performing surgery, the stakes are high. Widespread adoption of Electronic Health Record (EHR) and Computerized Provider Order Entry (CPOE) systems makes patient selection using a computer screen a frequent task for clinicians. Careful design of the user interface can help mitigate the problem by helping providers recall their patients' identities, accurately select their names, and spot errors before orders are submitted. We propose a catalog of twenty seven distinct user interface techniques, organized according to a task analysis. An associated video demonstrates eighteen of those techniques. EHR designers who consider a wider range of human-computer interaction techniques could reduce selection errors, but verification of efficacy is still needed.

  10. Beam-pointing error compensation method of phased array radar seeker with phantom-bit technology

    Directory of Open Access Journals (Sweden)

    Qiuqiu WEN

    2017-06-01

    Full Text Available A phased array radar seeker (PARS must be able to effectively decouple body motion and accurately extract the line-of-sight (LOS rate for target missile tracking. In this study, the real-time two-channel beam pointing error (BPE compensation method of PARS for LOS rate extraction is designed. The PARS discrete beam motion principium is analyzed, and the mathematical model of beam scanning control is finished. According to the principle of the antenna element shift phase, both the antenna element shift phase law and the causes of beam-pointing error under phantom-bit conditions are analyzed, and the effect of BPE caused by phantom-bit technology (PBT on the extraction accuracy of the LOS rate is examined. A compensation method is given, which includes coordinate transforms, beam angle margin compensation, and detector dislocation angle calculation. When the method is used, the beam angle margin in the pitch and yaw directions is calculated to reduce the effect of the missile body disturbance and to improve LOS rate extraction precision by compensating for the detector dislocation angle. The simulation results validate the proposed method.

  11. Refractive errors in patients attending a private hospital in Jos, Nigeria

    African Journals Online (AJOL)

    2013-05-02

    May 2, 2013 ... of 6/9 or less and showed improvement in distance vision of one or more ... ninety eight patients were seen at the hospital for various eye problems. ... Two hundred twenty one (36.8%) of patients with refractive error were ... Other risk factors are ..... Myopia profile in Copenhagen medical students 1996‑98.

  12. Patient and nurse safety: how information technology makes a difference.

    Science.gov (United States)

    Simpson, Roy L

    2005-01-01

    The Institute of Medicine's landmark report asserted medical error is seldom the fault of individuals, but the result of faulty healthcare policy/procedure systems. Numerous studies have shown that information technology can shore up weak systems. For nursing, information technology plays a key role in protecting patients by eliminating nursing mistakes and protecting nurses by reducing their negative exposure. However, managing information technology is a function of managing the people who use it. This article examines critical issues that impact patient and nurse safety, both physical and professional. It discusses the importance of eliminating the culture of blame, the requirements of process change, how to implement technology in harmony with the organization and the significance of vision.

  13. Performance monitoring and error significance in patients with obsessive-compulsive disorder.

    Science.gov (United States)

    Endrass, Tanja; Schuermann, Beate; Kaufmann, Christan; Spielberg, Rüdiger; Kniesche, Rainer; Kathmann, Norbert

    2010-05-01

    Performance monitoring has been consistently found to be overactive in obsessive-compulsive disorder (OCD). The present study examines whether performance monitoring in OCD is adjusted with error significance. Therefore, errors in a flanker task were followed by neutral (standard condition) or punishment feedbacks (punishment condition). In the standard condition patients had significantly larger error-related negativity (ERN) and correct-related negativity (CRN) ampliudes than controls. But, in the punishment condition groups did not differ in ERN and CRN amplitudes. While healthy controls showed an amplitude enhancement between standard and punishment condition, OCD patients showed no variation. In contrast, group differences were not found for the error positivity (Pe): both groups had larger Pe amplitudes in the punishment condition. Results confirm earlier findings of overactive error monitoring in OCD. The absence of a variation with error significance might indicate that OCD patients are unable to down-regulate their monitoring activity according to external requirements. Copyright 2010 Elsevier B.V. All rights reserved.

  14. Calculating radiotherapy margins based on Bayesian modelling of patient specific random errors

    International Nuclear Information System (INIS)

    Herschtal, A; Te Marvelde, L; Mengersen, K; Foroudi, F; Ball, D; Devereux, T; Pham, D; Greer, P B; Pichler, P; Eade, T; Kneebone, A; Bell, L; Caine, H; Hindson, B; Kron, T; Hosseinifard, Z

    2015-01-01

    Collected real-life clinical target volume (CTV) displacement data show that some patients undergoing external beam radiotherapy (EBRT) demonstrate significantly more fraction-to-fraction variability in their displacement (‘random error’) than others. This contrasts with the common assumption made by historical recipes for margin estimation for EBRT, that the random error is constant across patients. In this work we present statistical models of CTV displacements in which random errors are characterised by an inverse gamma (IG) distribution in order to assess the impact of random error variability on CTV-to-PTV margin widths, for eight real world patient cohorts from four institutions, and for different sites of malignancy. We considered a variety of clinical treatment requirements and penumbral widths. The eight cohorts consisted of a total of 874 patients and 27 391 treatment sessions. Compared to a traditional margin recipe that assumes constant random errors across patients, for a typical 4 mm penumbral width, the IG based margin model mandates that in order to satisfy the common clinical requirement that 90% of patients receive at least 95% of prescribed RT dose to the entire CTV, margins be increased by a median of 10% (range over the eight cohorts −19% to +35%). This substantially reduces the proportion of patients for whom margins are too small to satisfy clinical requirements. (paper)

  15. Refractive errors in patients attending a private hospital in Jos, Nigeria

    African Journals Online (AJOL)

    Six hundred one (20.7%) patients with distant VA which improved with refraction were considered for this analysis. Two hundred twenty one (36.8%) of patients with refractive error were visually impaired (VA <6/12-3/60). Blindness (<3/60 ‑ none perception of light) was seen in 91 (15.1%) of the patients, seven of whom were ...

  16. Radiodiagnostic errors by X-ray pictures of the chest taken at bed resting patients

    Energy Technology Data Exchange (ETDEWEB)

    Ross, D.; Deininger, H.K.

    1981-03-01

    The roentgenological findings of 383 cases have been compared with the anatomical and pathological diagnosis of the autopsy report. In 29% the radiodiagnosis was incorrect. About 70% of the X-ray examinations had to be carried out succenturiately at bed side in bedridden patients. The error rate of the interpretation of these examinations was higher than in examinations under standardized conditions. Especially, carcinomatous lymphangiosis, miliary tuberculosis and pulmonary embolism can be diagnosed badly in those incomplete X-ray pictures caused by the clinical situation of the bed resting patients. The publication analyses the most common errors in the diagnosis of cardiac and pulmonary diseases, and they will be demonstrated in examples.

  17. MOST COMMON TACTICAL ERRORS IN CHRONIC SYSTOLIC HEART FAILURE PATIENTS MANAGEMENT: PRACTICAL RECOMMENDATIONS

    Directory of Open Access Journals (Sweden)

    A. S. Poskrebysheva

    2012-01-01

    Full Text Available Treatment of chronic heart failure (CHF often can be a rather difficult task. Proper selection of therapy and strict adherence to the recommendations is vital in these patients. Unfortunately, in practice we often encounter with free interpretation of the recommendations, which leads to tactical errors and reduce the effectiveness of treatment. This article deals with the most common tactical errors, and contains recommendations for the management of patients with CHF, which can be very useful to the practitioner.

  18. MOST COMMON TACTICAL ERRORS IN CHRONIC SYSTOLIC HEART FAILURE PATIENTS MANAGEMENT: PRACTICAL RECOMMENDATIONS

    Directory of Open Access Journals (Sweden)

    A. S. Poskrebysheva

    2014-07-01

    Full Text Available Treatment of chronic heart failure (CHF often can be a rather difficult task. Proper selection of therapy and strict adherence to the recommendations is vital in these patients. Unfortunately, in practice we often encounter with free interpretation of the recommendations, which leads to tactical errors and reduce the effectiveness of treatment. This article deals with the most common tactical errors, and contains recommendations for the management of patients with CHF, which can be very useful to the practitioner.

  19. Impact of Communication Errors in Radiology on Patient Care, Customer Satisfaction, and Work-Flow Efficiency.

    Science.gov (United States)

    Siewert, Bettina; Brook, Olga R; Hochman, Mary; Eisenberg, Ronald L

    2016-03-01

    The purpose of this study is to analyze the impact of communication errors on patient care, customer satisfaction, and work-flow efficiency and to identify opportunities for quality improvement. We performed a search of our quality assurance database for communication errors submitted from August 1, 2004, through December 31, 2014. Cases were analyzed regarding the step in the imaging process at which the error occurred (i.e., ordering, scheduling, performance of examination, study interpretation, or result communication). The impact on patient care was graded on a 5-point scale from none (0) to catastrophic (4). The severity of impact between errors in result communication and those that occurred at all other steps was compared. Error evaluation was performed independently by two board-certified radiologists. Statistical analysis was performed using the chi-square test and kappa statistics. Three hundred eighty of 422 cases were included in the study. One hundred ninety-nine of the 380 communication errors (52.4%) occurred at steps other than result communication, including ordering (13.9%; n = 53), scheduling (4.7%; n = 18), performance of examination (30.0%; n = 114), and study interpretation (3.7%; n = 14). Result communication was the single most common step, accounting for 47.6% (181/380) of errors. There was no statistically significant difference in impact severity between errors that occurred during result communication and those that occurred at other times (p = 0.29). In 37.9% of cases (144/380), there was an impact on patient care, including 21 minor impacts (5.5%; result communication, n = 13; all other steps, n = 8), 34 moderate impacts (8.9%; result communication, n = 12; all other steps, n = 22), and 89 major impacts (23.4%; result communication, n = 45; all other steps, n = 44). In 62.1% (236/380) of cases, no impact was noted, but 52.6% (200/380) of cases had the potential for an impact. Among 380 communication errors in a radiology department, 37

  20. Radio Frequency Identification (RFID) technology and patient safety

    Science.gov (United States)

    Ajami, Sima; Rajabzadeh, Ahmad

    2013-01-01

    Background: Radio frequency identification (RFID) systems have been successfully applied in areas of manufacturing, supply chain, agriculture, transportation, healthcare, and services to name a few. However, the different advantages and disadvantages expressed in various studies of the challenges facing the technology of the use of the RFID technology have been met with skepticism by managers of healthcare organizations. The aim of this study was to express and display the role of RFID technology in improving patient safety and increasing the impact of it in healthcare. Materials and Methods: This study was non-systematical review, which the literature search was conducted with the help of libraries, books, conference proceedings, PubMed databases and also search engines available at Google, Google scholar in which published between 2004 and 2013 during Febuary 2013. We employed the following keywords and their combinations; RFID, healthcare, patient safety, medical errors, and medication errors in the searching areas of title, keywords, abstract, and full text. Results: The preliminary search resulted in 68 articles. After a careful analysis of the content of each paper, a total of 33 papers was selected based on their relevancy. Conclusion: We should integrate RFID with hospital information systems (HIS) and electronic health records (EHRs) and support it by clinical decision support systems (CDSS), it facilitates processes and reduce medical, medication and diagnosis errors. PMID:24381626

  1. Radio Frequency Identification (RFID) technology and patient safety.

    Science.gov (United States)

    Ajami, Sima; Rajabzadeh, Ahmad

    2013-09-01

    Radio frequency identification (RFID) systems have been successfully applied in areas of manufacturing, supply chain, agriculture, transportation, healthcare, and services to name a few. However, the different advantages and disadvantages expressed in various studies of the challenges facing the technology of the use of the RFID technology have been met with skepticism by managers of healthcare organizations. The aim of this study was to express and display the role of RFID technology in improving patient safety and increasing the impact of it in healthcare. This study was non-systematical review, which the literature search was conducted with the help of libraries, books, conference proceedings, PubMed databases and also search engines available at Google, Google scholar in which published between 2004 and 2013 during Febuary 2013. We employed the following keywords and their combinations; RFID, healthcare, patient safety, medical errors, and medication errors in the searching areas of title, keywords, abstract, and full text. The preliminary search resulted in 68 articles. After a careful analysis of the content of each paper, a total of 33 papers was selected based on their relevancy. We should integrate RFID with hospital information systems (HIS) and electronic health records (EHRs) and support it by clinical decision support systems (CDSS), it facilitates processes and reduce medical, medication and diagnosis errors.

  2. Radio Frequency Identification (RFID technology and patient safety

    Directory of Open Access Journals (Sweden)

    Sima Ajami

    2013-01-01

    Full Text Available Background: Radio frequency identification (RFID systems have been successfully applied in areas of manufacturing, supply chain, agriculture, transportation, healthcare, and services to name a few. However, the different advantages and disadvantages expressed in various studies of the challenges facing the technology of the use of the RFID technology have been met with skepticism by managers of healthcare organizations. The aim of this study was to express and display the role of RFID technology in improving patient safety and increasing the impact of it in healthcare. Materials and Methods: This study was non-systematical review, which the literature search was conducted with the help of libraries, books, conference proceedings, PubMed databases and also search engines available at Google, Google scholar in which published between 2004 and 2013 during Febuary 2013. We employed the following keywords and their combinations; RFID, healthcare, patient safety, medical errors, and medication errors in the searching areas of title, keywords, abstract, and full text. Results: The preliminary search resulted in 68 articles. After a careful analysis of the content of each paper, a total of 33 papers was selected based on their relevancy. Conclusion: We should integrate RFID with hospital information systems (HIS and electronic health records (EHRs and support it by clinical decision support systems (CDSS, it facilitates processes and reduce medical, medication and diagnosis errors.

  3. A mediation skills model to manage disclosure of errors and adverse events to patients.

    Science.gov (United States)

    Liebman, Carol B; Hyman, Chris Stern

    2004-01-01

    In 2002 Pennsylvania became the first state to impose on hospitals a statutory duty to notify patients in writing of a serious event. If the disclosure conversations are carefully planned, properly executed, and responsive to patients' needs, this new requirement creates possible benefits for both patient safety and litigation risk management. This paper describes a model for accomplishing these goals that encourages health care providers to communicate more effectively with patients following an adverse event or medical error, learn from mistakes, respond to the concerns of patients and families after an adverse event, and arrive at a fair and cost-effective resolution of valid claims.

  4. Evaluating and Predicting Patient Safety for Medical Devices With Integral Information Technology

    Science.gov (United States)

    2005-01-01

    323 Evaluating and Predicting Patient Safety for Medical Devices with Integral Information Technology Jiajie Zhang, Vimla L. Patel, Todd R...errors are due to inappropriate designs for user interactions, rather than mechanical failures. Evaluating and predicting patient safety in medical ...the users on the identified trouble spots in the devices. We developed two methods for evaluating and predicting patient safety in medical devices

  5. The frequency of diagnostic errors in radiologic reports depends on the patient's age

    International Nuclear Information System (INIS)

    Diaz, Sandra; Ekberg, Olle

    2010-01-01

    Background: Patients who undergo treatment may suffer preventable medical errors. Some of these errors are due to diagnostic imaging procedures. Purpose: To compare the frequency of diagnostic errors in different age groups in an urban European population. Material and Methods: A total of 19 129 reported radiologic examinations were included. During a 6-month period, the analyzed age groups were: children (aged 0-9 years), adults (40-49 years), and elderly (86-95 years). Results: The frequency of radiologic examinations per year was 0.3 in children, 0.6 in adults, and 1.1 in elderly. Significant errors were significantly more frequent in the elderly (1.7%) and children (1.4%) compared with adults (0.8%). There were 60 false-positive reports and 232 false-negative reports. Most errors were made by staff radiologists after hours when they reported on examinations outside their area of expertise. Conclusion: Diagnostic errors are more frequent in children and the elderly compared with middle-aged adults

  6. An intervention to decrease patient identification band errors in a children's hospital.

    Science.gov (United States)

    Hain, Paul D; Joers, B; Rush, M; Slayton, J; Throop, P; Hoagg, S; Allen, L; Grantham, J; Deshpande, J K

    2010-06-01

    Patient misidentification continues to be a quality and safety issue. There is a paucity of US data describing interventions to reduce identification band error rates. Monroe Carell Jr Children's Hospital at Vanderbilt. Percentage of patients with defective identification bands. Web-based surveys were sent, asking hospital personnel to anonymously identify perceived barriers to reaching zero defects with identification bands. Corrective action plans were created and implemented with ideas from leadership, front-line staff and the online survey. Data from unannounced audits of patient identification bands were plotted on statistical process control charts and shared monthly with staff. All hospital personnel were expected to "stop the line" if there were any patient identification questions. The first audit showed a defect rate of 20.4%. The original mean defect rate was 6.5%. After interventions and education, the new mean defect rate was 2.6%. (a) The initial rate of patient identification band errors in the hospital was higher than expected. (b) The action resulting in most significant improvement was staff awareness of the problem, with clear expectations to immediately stop the line if a patient identification error was present. (c) Staff surveys are an excellent source of suggestions for combating patient identification issues. (d) Continued audit and data collection is necessary for sustainable staff focus and continued improvement. (e) Statistical process control charts are both an effective method to track results and an easily understood tool for sharing data with staff.

  7. A Methodology for Validating Safety Heuristics Using Clinical Simulations: Identifying and Preventing Possible Technology-Induced Errors Related to Using Health Information Systems

    Science.gov (United States)

    Borycki, Elizabeth; Kushniruk, Andre; Carvalho, Christopher

    2013-01-01

    Internationally, health information systems (HIS) safety has emerged as a significant concern for governments. Recently, research has emerged that has documented the ability of HIS to be implicated in the harm and death of patients. Researchers have attempted to develop methods that can be used to prevent or reduce technology-induced errors. Some researchers are developing methods that can be employed prior to systems release. These methods include the development of safety heuristics and clinical simulations. In this paper, we outline our methodology for developing safety heuristics specific to identifying the features or functions of a HIS user interface design that may lead to technology-induced errors. We follow this with a description of a methodological approach to validate these heuristics using clinical simulations. PMID:23606902

  8. Can stimulating massage improve joint repositioning error in patients with knee osteoarthritis?

    DEFF Research Database (Denmark)

    Lund, Hans; Henriksen, Marius; Bartels, Else M

    2009-01-01

    PURPOSE: The purpose of this study was to investigate the effect of massage applied to the thigh muscles on joint repositioning error (JRE) in patients suffering from osteoarthritis (OA).We hypothesized that stimulating massage of the muscles around an osteoarthritic knee joint, could improve the...

  9. Detection of treatment setup errors between two CT scans for patients with head and neck cancer

    International Nuclear Information System (INIS)

    Ezzell, Leah C.; Hansen, Eric K.; Quivey, Jeanne M.; Xia Ping

    2007-01-01

    Accuracy of treatment setup for head and neck patients undergoing intensity-modulated radiation therapy is of paramount importance. The conventional method using orthogonal portal images can only detect translational setup errors while the most frequent setup errors for head and neck patients could be rotational errors. With the rapid development of image-guided radiotherapy, three-dimensional images are readily acquired and can be used to detect both translational and rotational setup errors. The purpose of this study is to determine the significance of rotational variations between two planning CT scans acquired for each of eight head and neck patients, who experienced substantial weight loss or tumor shrinkage. To this end, using a rigid body assumption, we developed an in-house computer program that utilizes matrix transformations to align point bony landmarks with an incremental best-fit routine. The program returns the quantified translational and rotational shifts needed to align the scans of each patient. The program was tested using a phantom for a set of known translational and rotational shifts. For comparison, a commercial treatment planning system was used to register the two CT scans and estimate the translational errors for these patients. For the eight patients, we found that the average magnitudes and standard deviations of the rotational shifts about the transverse, anterior-posterior, and longitudinal axes were 1.7±2.3 deg., 0.8±0.7 deg., and 1.8±1.1 deg., respectively. The average magnitudes and standard deviations of the translational shifts were 2.5±2.6 mm, 2.9±2.8 mm, 2.7±1.7 mm while the differences detected between our program and the CT-CT fusion method were 1.8±1.3 mm, 3.3±5.4 mm, and 3.0±3.4 mm in the left-right, anterior-posterior, and superior-inferior directions, respectively. A trend of larger rotational errors resulting in larger translational differences between the two methods was observed. In conclusion, conventional

  10. Does applying technology throughout the medication use process improve patient safety with antineoplastics?

    Science.gov (United States)

    Bubalo, Joseph; Warden, Bruce A; Wiegel, Joshua J; Nishida, Tess; Handel, Evelyn; Svoboda, Leanne M; Nguyen, Lam; Edillo, P Neil

    2014-12-01

    Medical errors, in particular medication errors, continue to be a troublesome factor in the delivery of safe and effective patient care. Antineoplastic agents represent a group of medications highly susceptible to medication errors due to their complex regimens and narrow therapeutic indices. As the majority of these medication errors are frequently associated with breakdowns in poorly defined systems, developing technologies and evolving workflows seem to be a logical approach to provide added safeguards against medication errors. This article will review both the pros and cons of today's technologies and their ability to simplify the medication use process, reduce medication errors, improve documentation, improve healthcare costs and increase provider efficiency as relates to the use of antineoplastic therapy throughout the medication use process. Several technologies, mainly computerized provider order entry (CPOE), barcode medication administration (BCMA), smart pumps, electronic medication administration record (eMAR), and telepharmacy, have been well described and proven to reduce medication errors, improve adherence to quality metrics, and/or improve healthcare costs in a broad scope of patients. The utilization of these technologies during antineoplastic therapy is weak at best and lacking for most. Specific to the antineoplastic medication use system, the only technology with data to adequately support a claim of reduced medication errors is CPOE. In addition to the benefits these technologies can provide, it is also important to recognize their potential to induce new types of errors and inefficiencies which can negatively impact patient care. The utilization of technology reduces but does not eliminate the potential for error. The evidence base to support technology in preventing medication errors is limited in general but even more deficient in the realm of antineoplastic therapy. Though CPOE has the best evidence to support its use in the

  11. Evaluation of Setup Error Correction for Patients Using On Board Imager in Image Guided Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Soo Man [Dept. of Radiation Oncology, Kosin University Gospel Hospital, Busan (Korea, Republic of)

    2008-09-15

    To reduce side effects in image guided radiation therapy (IGRT) and to improve the quality of life of patients, also to meet accurate SETUP condition for patients, the various SETUP correction conditions were compared and evaluated by using on board imager (OBI) during the SETUP. Each 30 cases of the head, the neck, the chest, the belly, and the pelvis in 150 cases of IGRT patients was corrected after confirmation by using OBI at every 2-3 day. Also, the difference of the SETUP through the skin-marker and the anatomic SETUP through the OBI was evaluated. General SETUP errors (Transverse, Coronal, Sagittal) through the OBI at original SETUP position were Head and Neck: 1.3 mm, Brain: 2 mm, Chest: 3 mm, Abdoman: 3.7 mm, Pelvis: 4 mm. The patients with more that 3 mm in the error range were observed in the correction devices and the patient motions by confirming in treatment room. Moreover, in the case of female patients, the result came from the position of hairs during the Head and Neck, Brain tumor. Therefore, after another SETUP in each cases of over 3 mm in the error range, the treatment was carried out. Mean error values of each parts estimated after the correction were 1 mm for the head, 1.2 mm for the neck, 2.5 mm for the chest, 2.5 mm for the belly, and 2.6 mm for the pelvis. The result showed the correction of SETUP for each treatment through OBI is extremely difficult because of the importance of SETUP in radiation treatment. However, by establishing the average standard of the patients from this research result, the better patient satisfaction and treatment results could be obtained.

  12. Automatic detection of patient identification and positioning errors in radiotherapy treatment using 3D setup images

    OpenAIRE

    Jani, Shyam

    2015-01-01

    The success of modern radiotherapy treatment depends on the correct alignment of the radiation beams with the target region in the patient. In the conventional paradigm of image-guided radiation therapy, 2D or 3D setup images are taken immediately prior to treatment and are used by radiation therapy technologists to localize the patient to the same position as defined from the reference planning CT dataset. However, numerous reports in the literature have described errors during this step, wh...

  13. Evaluation of Setup Error Correction for Patients Using On Board Imager in Image Guided Radiation Therapy

    International Nuclear Information System (INIS)

    Kang, Soo Man

    2008-01-01

    To reduce side effects in image guided radiation therapy (IGRT) and to improve the quality of life of patients, also to meet accurate SETUP condition for patients, the various SETUP correction conditions were compared and evaluated by using on board imager (OBI) during the SETUP. Each 30 cases of the head, the neck, the chest, the belly, and the pelvis in 150 cases of IGRT patients was corrected after confirmation by using OBI at every 2-3 day. Also, the difference of the SETUP through the skin-marker and the anatomic SETUP through the OBI was evaluated. General SETUP errors (Transverse, Coronal, Sagittal) through the OBI at original SETUP position were Head and Neck: 1.3 mm, Brain: 2 mm, Chest: 3 mm, Abdoman: 3.7 mm, Pelvis: 4 mm. The patients with more that 3 mm in the error range were observed in the correction devices and the patient motions by confirming in treatment room. Moreover, in the case of female patients, the result came from the position of hairs during the Head and Neck, Brain tumor. Therefore, after another SETUP in each cases of over 3 mm in the error range, the treatment was carried out. Mean error values of each parts estimated after the correction were 1 mm for the head, 1.2 mm for the neck, 2.5 mm for the chest, 2.5 mm for the belly, and 2.6 mm for the pelvis. The result showed the correction of SETUP for each treatment through OBI is extremely difficult because of the importance of SETUP in radiation treatment. However, by establishing the average standard of the patients from this research result, the better patient satisfaction and treatment results could be obtained.

  14. Using total quality management approach to improve patient safety by preventing medication error incidences*.

    Science.gov (United States)

    Yousef, Nadin; Yousef, Farah

    2017-09-04

    Whereas one of the predominant causes of medication errors is a drug administration error, a previous study related to our investigations and reviews estimated that the incidences of medication errors constituted 6.7 out of 100 administrated medication doses. Therefore, we aimed by using six sigma approach to propose a way that reduces these errors to become less than 1 out of 100 administrated medication doses by improving healthcare professional education and clearer handwritten prescriptions. The study was held in a General Government Hospital. First, we systematically studied the current medication use process. Second, we used six sigma approach by utilizing the five-step DMAIC process (Define, Measure, Analyze, Implement, Control) to find out the real reasons behind such errors. This was to figure out a useful solution to avoid medication error incidences in daily healthcare professional practice. Data sheet was used in Data tool and Pareto diagrams were used in Analyzing tool. In our investigation, we reached out the real cause behind administrated medication errors. As Pareto diagrams used in our study showed that the fault percentage in administrated phase was 24.8%, while the percentage of errors related to prescribing phase was 42.8%, 1.7 folds. This means that the mistakes in prescribing phase, especially because of the poor handwritten prescriptions whose percentage in this phase was 17.6%, are responsible for the consequent) mistakes in this treatment process later on. Therefore, we proposed in this study an effective low cost strategy based on the behavior of healthcare workers as Guideline Recommendations to be followed by the physicians. This method can be a prior caution to decrease errors in prescribing phase which may lead to decrease the administrated medication error incidences to less than 1%. This improvement way of behavior can be efficient to improve hand written prescriptions and decrease the consequent errors related to administrated

  15. Identification of Special Patterns of Numerical Typographic Errors to Increases the Likelihood of Finding a Misplaced Patient File

    OpenAIRE

    Sun, Ying-Chou; Tang, Dah-Dian; Zeng, Qing; Greenes, Robert

    2001-01-01

    When a typographic error of a patient identification number occurs on a patient document such as an envelope for radiology films or the cover of a patient record, it will result in misplacement of the document. Once misplaced, such documents are often extremely difficult to recover. After analyzing 290 numerical typos, we found that errors do not occur randomly. Instead, many of the typos share certain specific patterns. Six major types of non-random numeral typographic error patterns have be...

  16. Identification of Special Patterns of Numerical Typographic Errors Increases the Likelihood of Finding a Misplaced Patient File

    OpenAIRE

    Sun, Ying-Chou; Tang, Dah-Dian; Zeng, Qing; Greenes, Robert

    2002-01-01

    When a typographic error of a patient identification number occurs on a patient document such as an envelope for radiology films or the cover of a patient record, it will result in misplacement of the document. Once misplaced, such documents are often extremely difficult to recover. After analyzing 290 numerical typos, we found that errors do not occur randomly. Instead, many of the typos share certain specific patterns. Six major types of non-random numeral typographic error patterns have be...

  17. Characteristics of number transcoding errors of Chinese- versus English-speaking Alzheimer's disease patients.

    Science.gov (United States)

    Ting, Simon Kang Seng; Chia, Pei Shi; Kwek, Kevin; Tan, Wilnard; Hameed, Shahul

    2016-10-01

    Number processing disorder is an acquired deficit in mathematical skills commonly observed in Alzheimer's disease (AD), usually as a consequence of neurological dysfunction. Common impairments include syntactic errors (800012 instead of 8012) and intrusion errors (8 thousand and 12 instead of eight thousand and twelve) in number transcoding tasks. This study aimed to understand the characterization of AD-related number processing disorder within an alphabetic language (English) and ideographical language (Chinese), and to investigate the differences between alphabetic and ideographic language processing. Chinese-speaking AD patients were hypothesized to make significantly more intrusion errors than English-speaking ones, due to the ideographical nature of both Chinese characters and Arabic numbers. A simplified number transcoding test derived from EC301 battery was administered to AD patients. Chinese-speaking AD patients made significantly more intrusion errors (p = 0.001) than English speakers. This demonstrates that number processing in an alphabetic language such as English does not function in the same manner as in Chinese. The impaired inhibition capability likely contributes to such observations due to its competitive lexical representation in brain for Chinese speakers.

  18. A novel method to correct for pitch and yaw patient setup errors in helical tomotherapy

    International Nuclear Information System (INIS)

    Boswell, Sarah A.; Jeraj, Robert; Ruchala, Kenneth J.; Olivera, Gustavo H.; Jaradat, Hazim A.; James, Joshua A.; Gutierrez, Alonso; Pearson, Dave; Frank, Gary; Mackie, T. Rock

    2005-01-01

    An accurate means of determining and correcting for daily patient setup errors is important to the cancer outcome in radiotherapy. While many tools have been developed to detect setup errors, difficulty may arise in accurately adjusting the patient to account for the rotational error components. A novel, automated method to correct for rotational patient setup errors in helical tomotherapy is proposed for a treatment couch that is restricted to motion along translational axes. In tomotherapy, only a narrow superior/inferior section of the target receives a dose at any instant, thus rotations in the sagittal and coronal planes may be approximately corrected for by very slow continuous couch motion in a direction perpendicular to the scanning direction. Results from proof-of-principle tests indicate that the method improves the accuracy of treatment delivery, especially for long and narrow targets. Rotational corrections about an axis perpendicular to the transverse plane continue to be implemented easily in tomotherapy by adjustment of the initial gantry angle

  19. Evaluation of medication errors with implementation of electronic health record technology in the medical intensive care unit

    Directory of Open Access Journals (Sweden)

    Liao TV

    2017-05-01

    Full Text Available T Vivian Liao,1 Marina Rabinovich,2 Prasad Abraham,2 Sebastian Perez,3 Christiana DiPlotti,4 Jenny E Han,5 Greg S Martin,5 Eric Honig5 1Department of Pharmacy Practice, College of Pharmacy, Mercer Health Sciences Center, 2Department of Pharmacy and Clinical Nutrition, Grady Health System, 3Department of Surgery, Emory University, 4Pharmacy, Ingles Markets, 5Department of Medicine, Emory University, Atlanta, GA, USA Purpose: Patients in the intensive care unit (ICU are at an increased risk for medication errors (MEs and adverse drug events from multifactorial causes. ME rate ranges from 1.2 to 947 per 1,000 patient days in the medical ICU (MICU. Studies with the implementation of electronic health records (EHR have concluded that it significantly reduced overall prescribing errors and the number of errors that caused patient harm decreased. However, other types of errors, such as wrong dose and omission of required medications increased after EHR implementation. We sought to compare the number of MEs before and after EHR implementation in the MICU, with additional evaluation of error severity.Patients and methods: Prospective, observational, quality improvement study of all patients admitted to a single MICU service at an academic medical center. Patients were evaluated during four periods over 2 years: August–September 2010 (preimplementation; period I, January–February 2011 (2 months postimplementation; period II, August–September 2012 (21 months postimplementation; period III, and January–February 2013 (25 months postimplementation; period IV. All medication orders and administration records were reviewed by an ICU clinical pharmacist and ME was defined as a deviation from established standards for prescribing, dispensing, administering, or documenting medication. The frequency and classification of MEs were compared between groups by chi square; p<0.05 was considered significant.Results: There was a statistically significant increase

  20. Patient identification error among prostate needle core biopsy specimens--are we ready for a DNA time-out?

    Science.gov (United States)

    Suba, Eric J; Pfeifer, John D; Raab, Stephen S

    2007-10-01

    Patient identification errors in surgical pathology often involve switches of prostate or breast needle core biopsy specimens among patients. We assessed strategies for decreasing the occurrence of these uncommon and yet potentially catastrophic events. Root cause analyses were performed following 3 cases of patient identification error involving prostate needle core biopsy specimens. Patient identification errors in surgical pathology result from slips and lapses of automatic human action that may occur at numerous steps during pre-laboratory, laboratory and post-laboratory work flow processes. Patient identification errors among prostate needle biopsies may be difficult to entirely prevent through the optimization of work flow processes. A DNA time-out, whereby DNA polymorphic microsatellite analysis is used to confirm patient identification before radiation therapy or radical surgery, may eliminate patient identification errors among needle biopsies.

  1. The incidence and types of medication errors in patients receiving antiretroviral therapy in resource-constrained settings.

    Directory of Open Access Journals (Sweden)

    Kenneth Anene Agu

    Full Text Available This study assessed the incidence and types of medication errors, interventions and outcomes in patients on antiretroviral therapy (ART in selected HIV treatment centres in Nigeria.Of 69 health facilities that had program for active screening of medication errors, 14 were randomly selected for prospective cohort assessment. All patients who filled/refilled their antiretroviral medications between February 2009 and March 2011 were screened for medication errors using study-specific pharmaceutical care daily worksheet (PCDW. All potential or actual medication errors identified, interventions provided and the outcomes were documented in the PCDW. Interventions included pharmaceutical care in HIV training for pharmacists amongst others. Chi-square was used for inferential statistics and P0.05. The major medications errors identified were 26.4% incorrect ART regimens prescribed; 19.8% potential drug-drug interaction or contraindication present; and 16.6% duration and/or frequency of medication inappropriate. Interventions provided included 67.1% cases of prescriber contacted to clarify/resolve errors and 14.7% cases of patient counselling and education; 97.4% of potential/actual medication error(s were resolved.The incidence rate of medication errors was somewhat high; and majority of identified errors were related to prescription of incorrect ART regimens and potential drug-drug interactions; the prescriber was contacted and the errors were resolved in majority of cases. Active screening for medication errors is feasible in resource-limited settings following a capacity building intervention.

  2. Error signals in the subthalamic nucleus are related to post-error slowing in patients with Parkinson's disease

    NARCIS (Netherlands)

    Siegert, S.; Herrojo Ruiz, M.; Brücke, C.; Hueble, J.; Schneider, H.G.; Ullsperger, M.; Kühn, A.A.

    2014-01-01

    Error monitoring is essential for optimizing motor behavior. It has been linked to the medial frontal cortex, in particular to the anterior midcingulate cortex (aMCC). The aMCC subserves its performance-monitoring function in interaction with the basal ganglia (BG) circuits, as has been demonstrated

  3. Patient-oriented health technologies: Patients' perspectives and use.

    Science.gov (United States)

    Bauer, Amy M; Rue, Tessa; Munson, Sean A; Ghomi, Reza Hosseini; Keppel, Gina A; Cole, Allison M; Baldwin, Laura-Mae; Katon, Wayne

    2017-08-01

    For patient-oriented mobile health tools to contribute meaningfully to improving healthcare delivery, widespread acceptance and use of such tools by patients are critical. However, little is known about patients' attitudes toward using health technology and their willingness to share health data with providers. To investigate primary care patients' comfort sharing health information through mobile devices, and patients' awareness and use of patient portals. Patients (n=918) who visited one of 6 primary care clinics in the Northwest US completed a survey about health technology use, medical conditions, and demographics. More patients were comfortable sharing mobile health information with providers than having third parties store their information (62% vs 30%, Somers D=.33, phigher among patients with a chronic condition (AOR= 3.18, p=0.004). Comfort, awareness, and use of health technologies were variable. Practices introducing patient-facing health technologies should promote awareness, address concerns about data security, and provide education and training, especially to older adults and those with health literacy limitations. Patient-facing health technologies provide an opportunity for delivering scalable health education and self-management support, particularly for patients with chronic conditions who are already using patient portals.

  4. [Patient safety and errors in medicine: development, prevention and analyses of incidents].

    Science.gov (United States)

    Rall, M; Manser, T; Guggenberger, H; Gaba, D M; Unertl, K

    2001-06-01

    "Patient safety" and "errors in medicine" are issues gaining more and more prominence in the eyes of the public. According to newer studies, errors in medicine are among the ten major causes of death in association with the whole area of health care. A new era has begun incorporating attention to a "systems" approach to deal with errors and their causes in the health system. In other high-risk domains with a high demand for safety (such as the nuclear power industry and aviation) many strategies to enhance safety have been established. It is time to study these strategies, to adapt them if necessary and apply them to the field of medicine. These strategies include: to teach people how errors evolve in complex working domains and how types of errors are classified; the introduction of critical incident reporting systems that are free of negative consequences for the reporters; the promotion of continuous medical education; and the development of generic problem-solving skills incorporating the extensive use of realistic simulators wherever possible. Interestingly, the field of anesthesiology--within which realistic simulators were developed--is referred to as a model for the new patient safety movement. Despite this proud track record in recent times though, there is still much to be done even in the field of anesthesiology. Overall though, the most important strategy towards a long-term improvement in patient safety will be a change of "culture" throughout the entire health care system. The "culture of blame" focused on individuals should be replaced by a "safety culture", that sees errors and critical incidents as a problem of the whole organization. The acceptance of human fallability and an open-minded non-punitive analysis of errors in the sense of a "preventive and proactive safety culture" should lead to solutions at the systemic level. This change in culture can only be achieved with a strong commitment from the highest levels of an organization. Patient

  5. Improving Patient Safety With Error Identification in Chemotherapy Orders by Verification Nurses.

    Science.gov (United States)

    Baldwin, Abigail; Rodriguez, Elizabeth S

    2016-02-01

    The prevalence of medication errors associated with chemotherapy administration is not precisely known. Little evidence exists concerning the extent or nature of errors; however, some evidence demonstrates that errors are related to prescribing. This article demonstrates how the review of chemotherapy orders by a designated nurse known as a verification nurse (VN) at a National Cancer Institute-designated comprehensive cancer center helps to identify prescribing errors that may prevent chemotherapy administration mistakes and improve patient safety in outpatient infusion units. This article will describe the role of the VN and details of the verification process. To identify benefits of the VN role, a retrospective review and analysis of chemotherapy near-miss events from 2009-2014 was performed. A total of 4,282 events related to chemotherapy were entered into the Reporting to Improve Safety and Quality system. A majority of the events were categorized as near-miss events, or those that, because of chance, did not result in patient injury, and were identified at the point of prescribing.

  6. Rotational patient setup errors in IGRT with XVI system in Elekta Synergy and their clinical relevance

    International Nuclear Information System (INIS)

    Madhusudhana Sresty, N.V.N.; Muralidhar, K.R.; Raju, A.K.; Sha, R.L.; Ramanjappa

    2008-01-01

    The goal of Image Guided Radiotherapy (IGRT) is to improve the accuracy of treatment delivery. In this technique, it is possible to get volumetric images of patient anatomy before delivery of treatment.XVI( release 3.5) system in Elekta Synergy linear accelerator (Elekta,Crawley,UK) has the potential to ensure that, the relative positions of the target volume is same as in the treatment plan. It involves acquiring planar images produced by a kilo Voltage cone beam rotating about the patient in the treatment position. After 3 dimensional match between reference and localization images, the system gives rotational errors also along with translational shifts. One can easily perform translational shifts with treatment couch. But rotational shifts cannot be performed. Most of the studies dealt with translational shifts only. Few studies reported regarding rotational errors. It is found that in the treatment of elongated targets, even small rotational errors can show difference in results. The main objectives of this study is 1) To verify the magnitude of rotational errors in different clinical sites observed and to compare with the other reports. 2) To find its clinical relevance 3) To find difference in rotational shift results with improper selection of kV collimator

  7. Per-beam, planar IMRT QA passing rates do not predict clinically relevant patient dose errors

    Energy Technology Data Exchange (ETDEWEB)

    Nelms, Benjamin E.; Zhen Heming; Tome, Wolfgang A. [Canis Lupus LLC and Department of Human Oncology, University of Wisconsin, Merrimac, Wisconsin 53561 (United States); Department of Medical Physics, University of Wisconsin, Madison, Wisconsin 53705 (United States); Departments of Human Oncology, Medical Physics, and Biomedical Engineering, University of Wisconsin, Madison, Wisconsin 53792 (United States)

    2011-02-15

    Purpose: The purpose of this work is to determine the statistical correlation between per-beam, planar IMRT QA passing rates and several clinically relevant, anatomy-based dose errors for per-patient IMRT QA. The intent is to assess the predictive power of a common conventional IMRT QA performance metric, the Gamma passing rate per beam. Methods: Ninety-six unique data sets were created by inducing four types of dose errors in 24 clinical head and neck IMRT plans, each planned with 6 MV Varian 120-leaf MLC linear accelerators using a commercial treatment planning system and step-and-shoot delivery. The error-free beams/plans were used as ''simulated measurements'' (for generating the IMRT QA dose planes and the anatomy dose metrics) to compare to the corresponding data calculated by the error-induced plans. The degree of the induced errors was tuned to mimic IMRT QA passing rates that are commonly achieved using conventional methods. Results: Analysis of clinical metrics (parotid mean doses, spinal cord max and D1cc, CTV D95, and larynx mean) vs IMRT QA Gamma analysis (3%/3 mm, 2/2, 1/1) showed that in all cases, there were only weak to moderate correlations (range of Pearson's r-values: -0.295 to 0.653). Moreover, the moderate correlations actually had positive Pearson's r-values (i.e., clinically relevant metric differences increased with increasing IMRT QA passing rate), indicating that some of the largest anatomy-based dose differences occurred in the cases of high IMRT QA passing rates, which may be called ''false negatives.'' The results also show numerous instances of false positives or cases where low IMRT QA passing rates do not imply large errors in anatomy dose metrics. In none of the cases was there correlation consistent with high predictive power of planar IMRT passing rates, i.e., in none of the cases did high IMRT QA Gamma passing rates predict low errors in anatomy dose metrics or vice versa

  8. Per-beam, planar IMRT QA passing rates do not predict clinically relevant patient dose errors

    International Nuclear Information System (INIS)

    Nelms, Benjamin E.; Zhen Heming; Tome, Wolfgang A.

    2011-01-01

    Purpose: The purpose of this work is to determine the statistical correlation between per-beam, planar IMRT QA passing rates and several clinically relevant, anatomy-based dose errors for per-patient IMRT QA. The intent is to assess the predictive power of a common conventional IMRT QA performance metric, the Gamma passing rate per beam. Methods: Ninety-six unique data sets were created by inducing four types of dose errors in 24 clinical head and neck IMRT plans, each planned with 6 MV Varian 120-leaf MLC linear accelerators using a commercial treatment planning system and step-and-shoot delivery. The error-free beams/plans were used as ''simulated measurements'' (for generating the IMRT QA dose planes and the anatomy dose metrics) to compare to the corresponding data calculated by the error-induced plans. The degree of the induced errors was tuned to mimic IMRT QA passing rates that are commonly achieved using conventional methods. Results: Analysis of clinical metrics (parotid mean doses, spinal cord max and D1cc, CTV D95, and larynx mean) vs IMRT QA Gamma analysis (3%/3 mm, 2/2, 1/1) showed that in all cases, there were only weak to moderate correlations (range of Pearson's r-values: -0.295 to 0.653). Moreover, the moderate correlations actually had positive Pearson's r-values (i.e., clinically relevant metric differences increased with increasing IMRT QA passing rate), indicating that some of the largest anatomy-based dose differences occurred in the cases of high IMRT QA passing rates, which may be called ''false negatives.'' The results also show numerous instances of false positives or cases where low IMRT QA passing rates do not imply large errors in anatomy dose metrics. In none of the cases was there correlation consistent with high predictive power of planar IMRT passing rates, i.e., in none of the cases did high IMRT QA Gamma passing rates predict low errors in anatomy dose metrics or vice versa. Conclusions: There is a lack of correlation between

  9. Patient feedback design for stroke rehabilitation technology

    NARCIS (Netherlands)

    Tetteroo, D.; Willems, L.; Markopoulos, P.; Fred, A.; Gamboa, H.; Elias, D.

    2015-01-01

    The use of technology in stroke rehabilitation is increasingly common. An important aspect in stroke rehabilitation is feedback towards the patient, but research on how such feedback should be designed in stroke rehabilitation technology is scarce. Therefore, in this paper we describe an exploratory

  10. [Medication errors in a hospital emergency department: study of the current situation and critical points for improving patient safety].

    Science.gov (United States)

    Pérez-Díez, Cristina; Real-Campaña, José Manuel; Noya-Castro, María Carmen; Andrés-Paricio, Felicidad; Reyes Abad-Sazatornil, María; Bienvenido Povar-Marco, Javier

    2017-01-01

    To determine the frequency of medication errors and incident types in a tertiary-care hospital emergency department. To quantify and classify medication errors and identify critical points where measures should be implemented to improve patient safety. Prospective direct-observation study to detect errors made in June and July 2016. The overall error rate was 23.7%. The most common errors were made while medications were administered (10.9%). We detected 1532 incidents: 53.6% on workdays (P=.001), 43.1% during the afternoon/evening shift (P=.004), and 43.1% in observation areas (P=.004). The medication error rate was significant. Most errors and incidents occurred during the afternoon/evening shift and in the observation area. Most errors were related to administration of medications.

  11. Radiodiagnostic errors by X-ray pictures of the chest taken at bed resting patients

    International Nuclear Information System (INIS)

    Ross, D.; Deininger, H.K.

    1981-01-01

    The roentgenological findings of 383 cases have been compared with the anatomical and pathological diagnosis of the autopsy report. In 29% the radiodiagnosis was incorrect. About 70% of the X-ray examinations had to be carried out succenturiately at bed side in bedridden patients. The error rate of the interpretation of these examinations was higher than in examinations under standardized conditions. Especially, carcinomatous lymphangiosis, miliary tuberculosis and pulmonary embolism can be diagnosed badly in those incomplete X-ray pictures caused by the clinical situation of the bed resting patients. The publication analyses the most common errors in the diagnosis of cardiac and pulmonary diseases, and they will be demonstrated in examples. (orig.) [de

  12. Learned helplessness, cognitive errors and perfectionism in depressed and non-depressed chronic pain patients

    OpenAIRE

    2014-01-01

    M.A. (Clinical Psychology) The increasing interest in cognitive factors both in the literature on pain and in developments in research on depression has led to the present study, where cognitive factors associated with depression were investigated in clinical groups of chroni c pa in patients. The cognitive factors studied were learned helplessness (Seligman, 1975), cognitive errors and distortions (Beck, 1976), perfectionism (Bums, 19800 1980b), as well as hopelessness (Beck, 1974). It wa...

  13. Psychometric properties of the national eye institute refractive error correction quality-of-life questionnaire among Iranian patients

    Directory of Open Access Journals (Sweden)

    Amir H Pakpour

    2013-01-01

    Conclusions: The Iranian version of the NEI-RQL-42 is a valid and reliable instrument to assess refractive error correction quality-of-life in Iranian patients. Moreover this questionnaire can be used to evaluate the effectiveness of interventions in patients with refractive errors.

  14. [Prospective assessment of medication errors in critically ill patients in a university hospital].

    Science.gov (United States)

    Salazar L, Nicole; Jirón A, Marcela; Escobar O, Leslie; Tobar, Eduardo; Romero, Carlos

    2011-11-01

    Critically ill patients are especially vulnerable to medication errors (ME) due to their severe clinical situation and the complexities of their management. To determine the frequency and characteristics of ME and identify shortcomings in the processes of medication management in an Intensive Care Unit. During a 3 months period, an observational prospective and randomized study was carried out in the ICU of a university hospital. Every step of patient's medication management (prescription, transcription, dispensation, preparation and administration) was evaluated by an external trained professional. Steps with higher frequency of ME and their therapeutic groups involved were identified. Medications errors were classified according to the National Coordinating Council for Medication Error Reporting and Prevention. In 52 of 124 patients evaluated, 66 ME were found in 194 drugs prescribed. In 34% of prescribed drugs, there was at least 1 ME during its use. Half of ME occurred during medication administration, mainly due to problems in infusion rates and schedule times. Antibacterial drugs had the highest rate of ME. We found a 34% rate of ME per drug prescribed, which is in concordance with international reports. The identification of those steps more prone to ME in the ICU, will allow the implementation of an intervention program to improve the quality and security of medication management.

  15. Patient and tissue identification in the assisted reproductive technology laboratory.

    Science.gov (United States)

    Pomeroy, Kimball O; Racowsky, Catherine

    2012-06-01

    Several high-profile cases involving in vitro fertilization have recently received considerable media attention and highlight the importance of assuring patient and tissue identification. Within the assisted reproductive technology (ART) laboratory, there are many steps where wrong patient or tissue identity could have drastic results. Erroneous identity can result in tragic consequences for the patient, the laboratory, and for those working in the program as a whole. Such errors can result in enormous psychological and financial costs, as well as a loss in confidence. There are several critical steps that should be taken every single time and for each specific procedure performed in the ART laboratory to ensure the correct identification of patients and their tissue. These steps should be detailed in protocols that include the method of identification, the two unique identifiers that will be used, the sources of these identifiers, and often a system in which more than one person is involved in the identification. Each protocol should ideally include a checklist that is actively used for the implementation of each procedure. The protocol should also indicate what to do if the identification does not match up, including rapid handling and notification of the patient involved in the error. All ART laboratories should instill in their employees an atmosphere of full and open disclosure for cases where mistakes are made. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  16. Dosage uniformity problems which occur due to technological errors in extemporaneously prepared suppositories in hospitals and pharmacies

    Science.gov (United States)

    Kalmár, Éva; Lasher, Jason Richard; Tarry, Thomas Dean; Myers, Andrea; Szakonyi, Gerda; Dombi, György; Baki, Gabriella; Alexander, Kenneth S.

    2013-01-01

    The availability of suppositories in Hungary, especially in clinical pharmacy practice, is usually provided by extemporaneous preparations. Due to the known advantages of rectal drug administration, its benefits are frequently utilized in pediatrics. However, errors during the extemporaneous manufacturing process can lead to non-homogenous drug distribution within the dosage units. To determine the root cause of these errors and provide corrective actions, we studied suppository samples prepared with exactly known errors using both cerimetric titration and HPLC technique. Our results show that the most frequent technological error occurs when the pharmacist fails to use the correct displacement factor in the calculations which could lead to a 4.6% increase/decrease in the assay in individual dosage units. The second most important source of error can occur when the molding excess is calculated solely for the suppository base. This can further dilute the final suppository drug concentration causing the assay to be as low as 80%. As a conclusion we emphasize that the application of predetermined displacement factors in calculations for the formulation of suppositories is highly important, which enables the pharmacist to produce a final product containing exactly the determined dose of an active substance despite the different densities of the components. PMID:25161378

  17. Catching errors with patient-specific pretreatment machine log file analysis.

    Science.gov (United States)

    Rangaraj, Dharanipathy; Zhu, Mingyao; Yang, Deshan; Palaniswaamy, Geethpriya; Yaddanapudi, Sridhar; Wooten, Omar H; Brame, Scott; Mutic, Sasa

    2013-01-01

    A robust, efficient, and reliable quality assurance (QA) process is highly desired for modern external beam radiation therapy treatments. Here, we report the results of a semiautomatic, pretreatment, patient-specific QA process based on dynamic machine log file analysis clinically implemented for intensity modulated radiation therapy (IMRT) treatments delivered by high energy linear accelerators (Varian 2100/2300 EX, Trilogy, iX-D, Varian Medical Systems Inc, Palo Alto, CA). The multileaf collimator machine (MLC) log files are called Dynalog by Varian. Using an in-house developed computer program called "Dynalog QA," we automatically compare the beam delivery parameters in the log files that are generated during pretreatment point dose verification measurements, with the treatment plan to determine any discrepancies in IMRT deliveries. Fluence maps are constructed and compared between the delivered and planned beams. Since clinical introduction in June 2009, 912 machine log file analyses QA were performed by the end of 2010. Among these, 14 errors causing dosimetric deviation were detected and required further investigation and intervention. These errors were the result of human operating mistakes, flawed treatment planning, and data modification during plan file transfer. Minor errors were also reported in 174 other log file analyses, some of which stemmed from false positives and unreliable results; the origins of these are discussed herein. It has been demonstrated that the machine log file analysis is a robust, efficient, and reliable QA process capable of detecting errors originating from human mistakes, flawed planning, and data transfer problems. The possibility of detecting these errors is low using point and planar dosimetric measurements. Copyright © 2013 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  18. Calculation errors of Set-up in patients with tumor location of prostate. Exploratory study; Calculo de errores de Set-up en pacientes con localizacion tumoral de prostata. Estudio exploratorio

    Energy Technology Data Exchange (ETDEWEB)

    Donis Gil, S.; Robayna Duque, B. E.; Jimenez Sosa, A.; Hernandez Armas, O.; Gonzalez Martin, A. E.; Hernandez Armas, J.

    2013-07-01

    The calculation of SM is done from errors in positioning (set-up). These errors are calculated from movements in 3D of the patient. This paper is an exploratory study of 20 patients with tumor location of prostate in which errors of set-up for two protocols of work are evaluated. (Author)

  19. Holistic approach for overlay and edge placement error to meet the 5nm technology node requirements

    Science.gov (United States)

    Mulkens, Jan; Slachter, Bram; Kubis, Michael; Tel, Wim; Hinnen, Paul; Maslow, Mark; Dillen, Harm; Ma, Eric; Chou, Kevin; Liu, Xuedong; Ren, Weiming; Hu, Xuerang; Wang, Fei; Liu, Kevin

    2018-03-01

    In this paper, we discuss the metrology methods and error budget that describe the edge placement error (EPE). EPE quantifies the pattern fidelity of a device structure made in a multi-patterning scheme. Here the pattern is the result of a sequence of lithography and etching steps, and consequently the contour of the final pattern contains error sources of the different process steps. EPE is computed by combining optical and ebeam metrology data. We show that high NA optical scatterometer can be used to densely measure in device CD and overlay errors. Large field e-beam system enables massive CD metrology which is used to characterize the local CD error. Local CD distribution needs to be characterized beyond 6 sigma, and requires high throughput e-beam system. We present in this paper the first images of a multi-beam e-beam inspection system. We discuss our holistic patterning optimization approach to understand and minimize the EPE of the final pattern. As a use case, we evaluated a 5-nm logic patterning process based on Self-Aligned-QuadruplePatterning (SAQP) using ArF lithography, combined with line cut exposures using EUV lithography.

  20. Primary care physicians' willingness to disclose oncology errors involving multiple providers to patients.

    Science.gov (United States)

    Mazor, Kathleen; Roblin, Douglas W; Greene, Sarah M; Fouayzi, Hassan; Gallagher, Thomas H

    2016-10-01

    Full disclosure of harmful errors to patients, including a statement of regret, an explanation, acceptance of responsibility and commitment to prevent recurrences is the current standard for physicians in the USA. To examine the extent to which primary care physicians' perceptions of event-level, physician-level and organisation-level factors influence intent to disclose a medical error in challenging situations. Cross-sectional survey containing two hypothetical vignettes: (1) delayed diagnosis of breast cancer, and (2) care coordination breakdown causing a delayed response to patient symptoms. In both cases, multiple physicians shared responsibility for the error, and both involved oncology diagnoses. The study was conducted in the context of the HMO Cancer Research Network Cancer Communication Research Center. Primary care physicians from three integrated healthcare delivery systems located in Washington, Massachusetts and Georgia; responses from 297 participants were included in these analyses. The dependent variable intent to disclose included intent to provide an apology, an explanation, information about the cause and plans for preventing recurrences. Independent variables included event-level factors (responsibility for the event, perceived seriousness of the event, predictions about a lawsuit); physician-level factors (value of patient-centred communication, communication self-efficacy and feelings about practice); organisation-level factors included perceived support for communication and time constraints. A majority of respondents would not fully disclose in either situation. The strongest predictors of disclosure were perceived personal responsibility, perceived seriousness of the event and perceived value of patient-centred communication. These variables were consistently associated with intent to disclose. To make meaningful progress towards improving disclosure; physicians, risk managers, organisational leaders, professional organisations and

  1. Analysis of liquid medication dose errors made by patients and caregivers using alternative measuring devices.

    Science.gov (United States)

    Ryu, Gyeong Suk; Lee, Yu Jeung

    2012-01-01

    Patients use several types of devices to measure liquid medication. Using a criterion ranging from a 10% to 40% variation from a target 5 mL for a teaspoon dose, previous studies have found that a considerable proportion of patients or caregivers make errors when dosing liquid medication with measuring devices. To determine the rate and magnitude of liquid medication dose errors that occur with patient/caregiver use of various measuring devices in a community pharmacy. Liquid medication measurements by patients or caregivers were observed in a convenience sample of community pharmacy patrons in Korea during a 2-week period in March 2011. Participants included all patients or caregivers (N = 300) who came to the pharmacy to buy over-the-counter liquid medication or to have a liquid medication prescription filled during the study period. The participants were instructed by an investigator who was also a pharmacist to select their preferred measuring devices from 6 alternatives (etched-calibration dosing cup, printed-calibration dosing cup, dosing spoon, syringe, dispensing bottle, or spoon with a bottle adapter) and measure a 5 mL dose of Coben (chlorpheniramine maleate/phenylephrine HCl, Daewoo Pharm. Co., Ltd) syrup using the device of their choice. The investigator used an ISOLAB graduated cylinder (Germany, blue grad, 10 mL) to measure the amount of syrup dispensed by the study participants. Participant characteristics were recorded including gender, age, education level, and relationship to the person for whom the medication was intended. Of the 300 participants, 257 (85.7%) were female; 286 (95.3%) had at least a high school education; and 282 (94.0%) were caregivers (parent or grandparent) for the patient. The mean (SD) measured dose was 4.949 (0.378) mL for the 300 participants. In analysis of variance of the 6 measuring devices, the greatest difference from the 5 mL target was a mean 5.552 mL for 17 subjects who used the regular (etched) dosing cup and 4

  2. Improvement in Detection of Wrong-Patient Errors When Radiologists Include Patient Photographs in Their Interpretation of Portable Chest Radiographs.

    Science.gov (United States)

    Tridandapani, Srini; Olsen, Kevin; Bhatti, Pamela

    2015-12-01

    This study was conducted to determine whether facial photographs obtained simultaneously with radiographs improve radiologists' detection rate of wrong-patient errors, when they are explicitly asked to include the photographs in their evaluation. Radiograph-photograph combinations were obtained from 28 patients at the time of portable chest radiography imaging. From these, pairs of radiographs were generated. Each unique pair consisted of one new and one old (comparison) radiograph. Twelve pairs of mismatched radiographs (i.e., pairs containing radiographs of different patients) were also generated. In phase 1 of the study, 5 blinded radiologist observers were asked to interpret 20 pairs of radiographs without the photographs. In phase 2, each radiologist interpreted another 20 pairs of radiographs with the photographs. Radiologist observers were not instructed about the purpose of the photographs but were asked to include the photographs in their review. The detection rate of mismatched errors was recorded along with the interpretation time for each session for each observer. The two-tailed Fisher exact test was used to evaluate differences in mismatch detection rates between the two phases. A p value of error detection rates without (0/20 = 0%) and with (17/18 = 94.4%) photographs were different (p = 0.0001). The average interpretation times for the set of 20 radiographs were 26.45 (SD 8.69) and 20.55 (SD 3.40) min, for phase 1 and phase 2, respectively (two-tailed Student t test, p = 0.1911). When radiologists include simultaneously obtained photographs in their review of portable chest radiographs, there is a significant improvement in the detection of labeling errors. No statistically significant difference in interpretation time was observed. This may lead to improved patient safety without affecting radiologists' throughput.

  3. Erro médico em pacientes hospitalizados Medical errors in hospitalized patients

    Directory of Open Access Journals (Sweden)

    Manoel de Carvalho

    2002-01-01

    sistema, e encarados como oportunidade de revisão do processo e aprimoramento da assistência prestada ao paciente.Objective: to review the current literature and to discuss medical errors in hospitalized patients emphasizing its incidence, predisposing factors and prevention mechanism. Special attention is given to medication errors and adverse drug events in newborn infants and pediatric patients. Sources: bibliographic review of the current literature through electronic search in Medline data-base, with selection of the most relevant articles. Summary of the findings: even though most medical errors are not reported, it is important to notice that its incidence is greater than previously assumed. In the USA, approximately one million of patients/year are victims of medical errors and adverse drug events. Today, deaths resulting from these episodes are the fourth cause of mortality in the USA. In neonatal and pediatric intensive care units, where the complexity and frequency of technical procedures are high, medical errors are frequent. Fifteen percent of all admissions to a neonatal intensive care unit is followed by medical errors. Most of these errors occur during night shifts and include incorrect administration of drugs (35% and errors regarding the interpretation of medical prescription (26%. Environmental factors (noise, heat, psychological factors (anxiety, stress and physiologic factors (fatigue, absence of sleep contribute to the occurrence of errors. Recent study shows that after working 24 hours without sleeping, the performance of a health professional is similar to a legally drunk person (serum alcohol level > 0.08%. Conclusions: errors are part of human behavior. The prevention of errors should include a careful review of the organizational system. Medical errors should be seen as an opportunity to change or re-structure the system and to improve the quality of health care delivered and patient safety.

  4. Analysis of Factors and Medical Errors Involved in Patient Complaints in a European Emergency Department

    Directory of Open Access Journals (Sweden)

    Pauline Haroutunian

    2017-12-01

    Full Text Available Introduction: Patients’ complaints from Emergency Departments (ED are frequent and can be used as a quality assurance indicator. Objective: Factors contributing to patients’ complaints (PCs in the emergency department were analyzed.  Methods: It was a retrospective cohort study, the qualitative variables of patients’ complaints visiting ED of a university hospital were compared with Chi-Square and t test tests. Results: Eighty-five PC were analyzed. The factors contributing to PC were: communication (n=26, length of stay (LOS (n=24, diagnostic errors (n=21, comfort and privacy issues (n=7, pain management (n=6, inappropriate treatment (n=6, delay of care and billing issues (n=3. PCs were more frequent when patients were managed by residents, during night shifts, weekends, Saturdays, Mondays, January and June. Moreover, the factors contributing to diagnostic errors were due to poor communication, non-adherence to guidelines and lack of systematic proofreading of X-rays. In 98% of cases, disputes were resolved by apology and explanation and three cases resulted in financial compensation. Conclusion: Poor communication, LOS and medical errors are factors contributing to PCs. Improving communication, resolving issues leading to slow health care provision, adequate staffing and supervision of trainees may reduce PCs.

  5. Parenteral nutrition in patients with inborn errors of metabolism - a therapeutic problem.

    Science.gov (United States)

    Kaluzny, L; Szczepanik, M; Siwinska-Mrozek, Z; Borkowska-Klos, M; Cichy, W; Walkowiak, J

    2014-06-01

    Parenteral nutrition is now a standard part of supportive treatment in pediatric departments. We describe four cases in which parenteral nutrition was extremely difficult due to coincidence with inborn errors of metabolism. The first two cases was fatty acid beta-oxidation disorders associated with necrotizing enterocolitis and congenital heart disease. Thus, limitations of intravenous lipid intake made it difficult to maintain a good nutritional status. The third case was phenylketonuria associated with a facial region tumour (rhabdomyosarcoma), in which parenteral nutrition was complicated because of a high phenylalanine content in the amino acid formulas for parenteral nutrition. The fourth patient was a child with late-diagnosed tyrosinemia type 1, complicated with encephalopathy - during intensive care treatment the patient needed nutritional support, including parenteral nutrition - we observed amino acid formula problems similar to those in the phenylketonuria patient. Parenteral nutrition in children with inborn errors of metabolism is a rare, but very important therapeutic problem. Total parenteral nutrition formulas are not prepared for this group of diseases.

  6. The introduction of an acute physiological support service for surgical patients is an effective error reduction strategy.

    Science.gov (United States)

    Clarke, D L; Kong, V Y; Naidoo, L C; Furlong, H; Aldous, C

    2013-01-01

    Acute surgical patients are particularly vulnerable to human error. The Acute Physiological Support Team (APST) was created with the twin objectives of identifying high-risk acute surgical patients in the general wards and reducing both the incidence of error and impact of error on these patients. A number of error taxonomies were used to understand the causes of human error and a simple risk stratification system was adopted to identify patients who are particularly at risk of error. During the period November 2012-January 2013 a total of 101 surgical patients were cared for by the APST at Edendale Hospital. The average age was forty years. There were 36 females and 65 males. There were 66 general surgical patients and 35 trauma patients. Fifty-six patients were referred on the day of their admission. The average length of stay in the APST was four days. Eleven patients were haemo-dynamically unstable on presentation and twelve were clinically septic. The reasons for referral were sepsis,(4) respiratory distress,(3) acute kidney injury AKI (38), post-operative monitoring (39), pancreatitis,(3) ICU down-referral,(7) hypoxia,(5) low GCS,(1) coagulopathy.(1) The mortality rate was 13%. A total of thirty-six patients experienced 56 errors. A total of 143 interventions were initiated by the APST. These included institution or adjustment of intravenous fluids (101), blood transfusion,(12) antibiotics,(9) the management of neutropenic sepsis,(1) central line insertion,(3) optimization of oxygen therapy,(7) correction of electrolyte abnormality,(8) correction of coagulopathy.(2) CONCLUSION: Our intervention combined current taxonomies of error with a simple risk stratification system and is a variant of the defence in depth strategy of error reduction. We effectively identified and corrected a significant number of human errors in high-risk acute surgical patients. This audit has helped understand the common sources of error in the general surgical wards and will inform

  7. Classification of Patient Care Complexity: Cloud Technology.

    Science.gov (United States)

    de Oliveira Riboldi, Caren; Macedo, Andrea Barcellos Teixeira; Mergen, Thiane; Dias, Vera Lúcia Mendes; da Costa, Diovane Ghignatti; Malvezzi, Maria Luiza Falsarella; Magalhães, Ana Maria Muller; Silveira, Denise Tolfo

    2016-01-01

    Presentation of the computerized structure to implement, in a university hospital in the South of Brazil, the Patients Classification System of Perroca, which categorizes patients according to the care complexity. This solution also aims to corroborate a recent study at the hospital, which evidenced that the increasing workload presents a direct relation with the institutional quality indicators. The tools used were the Google applications with high productivity interconnecting the topic knowledge on behalf of the nursing professionals and information technology professionals.

  8. Leveraging Technology to Reduce Patient Transaction Costs.

    Science.gov (United States)

    Edlow, Richard C

    2015-01-01

    Medical practices are under significant pressure to provide superior customer service in an environment of declining or flat reimbursement. The solution for many practices involves the integration of a variety of third-party technologies that conveniently interface with one's electronic practice management and medical records systems. Typically, the applications allow the practice to reduce the cost of each patient interaction. Drilling down to quantify the cost of each individual patient interaction helps to determine the practicality of implementation.

  9. Strategies to increase patient safety in haemodialysis: Application of the modal analysis system of errors and effects (FEMA system

    Directory of Open Access Journals (Sweden)

    María Dolores Arenas Jiménez

    2017-11-01

    Full Text Available Background: Haemodialysis (HD patients are a high-risk population group. For these patients, an error could have catastrophic consequences. Therefore, system that ensures the safety of these patients in an environment with high technology and great interaction of the human factor is a requirement. Objectives: To show a systematic working approach, reproducible in any HD unit, which consists of recording the complications and errors that occurred during the HD session; defining which of those complications could be considered adverse event (AE, and therefore preventable; and carrying out a systematic analysis of them, as well as of underlying real or potential errors, evaluating their severity, frequency and detection; as well as establishing priorities for action (Failure Mode and Effects Analysis system [FMEA systems]. Methods: Retrospective analysis of the graphs of all HD sessions performed during one month (October 2015 on 97 patients, analysing all recorded complications. The consideration of these complications as AEs was based on a consensus among 13 health professionals and 2 patients. The severity, frequency and detection of each AE were evaluated by the FMEA system. Results: We analysed 1303 HD treatments in 97 patients. A total of 383 complications (1 every 3.4 HD treatments were recorded. Approximately 87.9% of them were deemed AEs and 23.7% complications related with patients’ underlying pathology. There was one AE every 3.8 HD treatments. Hypertension and hypotension were the most frequent AEs (42.7 and 27.5% of all AEs recorded, respectively. Vascular-access related AEs were one every 68.5 HD treatments. A total of 21 errors (1 every 62 HD treatments, mainly related to the HD technique and to the administration of prescribed medication, were registered. The highest risk priority number, according to the FMEA, corresponded to errors related to patient body weight; dysfunction/rupture of the catheter; and needle extravasation

  10. Preparing Emergency Medicine Residents to Disclose Medical Error Using Standardized Patients

    Directory of Open Access Journals (Sweden)

    Carmen N. Spalding

    2017-12-01

    Full Text Available Introduction Emergency Medicine (EM is a unique clinical learning environment. The American College of Graduate Medical Education Clinical Learning Environment Review Pathways to Excellence calls for “hands-on training” of disclosure of medical error (DME during residency. Training and practicing key elements of DME using standardized patients (SP may enhance preparedness among EM residents in performing this crucial skill in a clinical setting. Methods This training was developed to improve resident preparedness in DME in the clinical setting. Objectives included the following: the residents will be able to define a medical error; discuss ethical and professional standards of DME; recognize common barriers to DME; describe key elements in effective DME to patients and families; and apply key elements during a SP encounter. The four-hour course included didactic and experiential learning methods, and was created collaboratively by core EM faculty and subject matter experts in conflict resolution and healthcare simulation. Educational media included lecture, video exemplars of DME communication with discussion, small group case-study discussion, and SP encounters. We administered a survey assessing for preparedness in DME pre-and post-training. A critical action checklist was administered to assess individual performance of key elements of DME during the evaluated SP case. A total of 15 postgraduate-year 1 and 2 EM residents completed the training. Results After the course, residents reported increased comfort with and preparedness in performing several key elements in DME. They were able to demonstrate these elements in a simulated setting using SP. Residents valued the training, rating the didactic, SP sessions, and overall educational experience very high. Conclusion Experiential learning using SP is effective in improving resident knowledge of and preparedness in performing medical error disclosure. This educational module can be adapted

  11. Establishment and application of medication error classification standards in nursing care based on the International Classification of Patient Safety

    Directory of Open Access Journals (Sweden)

    Xiao-Ping Zhu

    2014-09-01

    Conclusion: Application of this classification system will help nursing administrators to accurately detect system- and process-related defects leading to medication errors, and enable the factors to be targeted to improve the level of patient safety management.

  12. Preventing errors in administration of parenteral drugs: the results of a four-year national patient safety program.

    NARCIS (Netherlands)

    Blok, C. de; Schilp, J.; Wagner, C.

    2013-01-01

    Objectives: To evaluate the implementation of a four-year national patient safety program concerning the parenteral drug administration process in the Netherlands. Methods: Structuring the preparation and administration process of parenteral drugs reduces the number of medication errors. A

  13. Errors in fracture diagnoses in the emergency department--characteristics of patients and diurnal variation

    DEFF Research Database (Denmark)

    Hallas, Peter; Ellingsen, Trond

    2006-01-01

    Evaluation of the circumstances related to errors in diagnosis of fractures at an Emergency Department may suggest ways to reduce the incidence of such errors.......Evaluation of the circumstances related to errors in diagnosis of fractures at an Emergency Department may suggest ways to reduce the incidence of such errors....

  14. [Patient identification errors and biological samples in the analytical process: Is it possible to improve patient safety?].

    Science.gov (United States)

    Cuadrado-Cenzual, M A; García Briñón, M; de Gracia Hills, Y; González Estecha, M; Collado Yurrita, L; de Pedro Moro, J A; Fernández Pérez, C; Arroyo Fernández, M

    2015-01-01

    Patient identification errors and biological samples are one of the problems with the highest risk factor in causing an adverse event in the patient. To detect and analyse the causes of patient identification errors in analytical requests (PIEAR) from emergency departments, and to develop improvement strategies. A process and protocol was designed, to be followed by all professionals involved in the requesting and performing of laboratory tests. Evaluation and monitoring indicators of PIEAR were determined, before and after the implementation of these improvement measures (years 2010-2014). A total of 316 PIEAR were detected in a total of 483,254 emergency service requests during the study period, representing a mean of 6.80/10,000 requests. Patient identification failure was the most frequent in all the 6-monthly periods assessed, with a significant difference (Perrors. However, we must continue working with this strategy, promoting a culture of safety for all the professionals involved, and trying to achieve the goal that 100% of the analytical and samples are properly identified. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

  15. SU-E-T-114: Analysis of MLC Errors On Gamma Pass Rates for Patient-Specific and Conventional Phantoms

    Energy Technology Data Exchange (ETDEWEB)

    Sterling, D; Ehler, E [University of Minnesota, Minneapolis, MN (United States)

    2015-06-15

    Purpose: To evaluate whether a 3D patient-specific phantom is better able to detect known MLC errors in a clinically delivered treatment plan than conventional phantoms. 3D printing may make fabrication of such phantoms feasible. Methods: Two types of MLC errors were introduced into a clinically delivered, non-coplanar IMRT, partial brain treatment plan. First, uniformly distributed random errors of up to 3mm, 2mm, and 1mm were introduced into the MLC positions for each field. Second, systematic MLC-bank position errors of 5mm, 3.5mm, and 2mm due to simulated effects of gantry and MLC sag were introduced. The original plan was recalculated with these errors on the original CT dataset as well as cylindrical and planar IMRT QA phantoms. The original dataset was considered to be a perfect 3D patient-specific phantom. The phantoms were considered to be ideal 3D dosimetry systems with no resolution limitations. Results: Passing rates for Gamma Index (3%/3mm and no dose threshold) were calculated on the 3D phantom, cylindrical phantom, and both on a composite and field-by-field basis for the planar phantom. Pass rates for 5mm systematic and 3mm random error were 86.0%, 89.6%, 98% and 98.3% respectively. For 3.5mm systematic and 2mm random error the pass rates were 94.7%, 96.2%, 99.2% and 99.2% respectively. For 2mm systematic error with 1mm random error the pass rates were 99.9%, 100%, 100% and 100% respectively. Conclusion: A 3D phantom with the patient anatomy is able to discern errors, both severe and subtle, that are not seen using conventional phantoms. Therefore, 3D phantoms may be beneficial for commissioning new treatment machines and modalities, patient-specific QA and end-to-end testing.

  16. SU-E-T-114: Analysis of MLC Errors On Gamma Pass Rates for Patient-Specific and Conventional Phantoms

    International Nuclear Information System (INIS)

    Sterling, D; Ehler, E

    2015-01-01

    Purpose: To evaluate whether a 3D patient-specific phantom is better able to detect known MLC errors in a clinically delivered treatment plan than conventional phantoms. 3D printing may make fabrication of such phantoms feasible. Methods: Two types of MLC errors were introduced into a clinically delivered, non-coplanar IMRT, partial brain treatment plan. First, uniformly distributed random errors of up to 3mm, 2mm, and 1mm were introduced into the MLC positions for each field. Second, systematic MLC-bank position errors of 5mm, 3.5mm, and 2mm due to simulated effects of gantry and MLC sag were introduced. The original plan was recalculated with these errors on the original CT dataset as well as cylindrical and planar IMRT QA phantoms. The original dataset was considered to be a perfect 3D patient-specific phantom. The phantoms were considered to be ideal 3D dosimetry systems with no resolution limitations. Results: Passing rates for Gamma Index (3%/3mm and no dose threshold) were calculated on the 3D phantom, cylindrical phantom, and both on a composite and field-by-field basis for the planar phantom. Pass rates for 5mm systematic and 3mm random error were 86.0%, 89.6%, 98% and 98.3% respectively. For 3.5mm systematic and 2mm random error the pass rates were 94.7%, 96.2%, 99.2% and 99.2% respectively. For 2mm systematic error with 1mm random error the pass rates were 99.9%, 100%, 100% and 100% respectively. Conclusion: A 3D phantom with the patient anatomy is able to discern errors, both severe and subtle, that are not seen using conventional phantoms. Therefore, 3D phantoms may be beneficial for commissioning new treatment machines and modalities, patient-specific QA and end-to-end testing

  17. Is it possible to eliminate patient identification errors in medical imaging?

    Science.gov (United States)

    Danaher, Luke A; Howells, Joan; Holmes, Penny; Scally, Peter

    2011-08-01

    The aim of this article is to review a system that validates and documents the process of ensuring the correct patient, correct site and side, and correct procedure (commonly referred to as the 3 C's) within medical imaging. A 4-step patient identification and procedure matching process was developed using health care and aviation models. The process was established in medical imaging departments after a successful interventional radiology pilot program. The success of the project was evaluated using compliance audit data, incident reporting data before and after the implementation of the process, and a staff satisfaction survey. There was 95% to 100% verification of site and side and 100% verification of correct patient, procedure, and consent. Correct patient data and side markers were present in 82% to 95% of cases. The number of incidents before and after the implementation of the 3 C's was difficult to assess because of a change in reporting systems and incident underreporting. More incidents are being reported, particularly "near misses." All near misses were related to incorrect patient identification stickers being placed on request forms. The majority of staff members surveyed found the process easy (55.8%), quick (47.7%), relevant (51.7%), and useful (60.9%). Although identification error is difficult to eliminate, practical initiatives can engender significant systems improvement in complex health care environments. Crown Copyright © 2011. Published by Elsevier Inc. All rights reserved.

  18. Radiologic head CT interpretation errors in pediatric abusive and non-abusive head trauma patients

    International Nuclear Information System (INIS)

    Kralik, Stephen F.; Finke, Whitney; Wu, Isaac C.; Ho, Chang Y.; Hibbard, Roberta A.; Hicks, Ralph A.

    2017-01-01

    Pediatric head trauma, including abusive head trauma, is a significant cause of morbidity and mortality. The purpose of this research was to identify and evaluate radiologic interpretation errors of head CTs performed on abusive and non-abusive pediatric head trauma patients from a community setting referred for a secondary interpretation at a tertiary pediatric hospital. A retrospective search identified 184 patients <5 years of age with head CT for known or potential head trauma who had a primary interpretation performed at a referring community hospital by a board-certified radiologist. Two board-certified fellowship-trained neuroradiologists at an academic pediatric hospital independently interpreted the head CTs, compared their interpretations to determine inter-reader discrepancy rates, and resolved discrepancies to establish a consensus second interpretation. The primary interpretation was compared to the consensus second interpretation using the RADPEER trademark scoring system to determine the primary interpretation-second interpretation overall and major discrepancy rates. MRI and/or surgical findings were used to validate the primary interpretation or second interpretation when possible. The diagnosis of abusive head trauma was made using clinical and imaging data by a child abuse specialist to separate patients into abusive head trauma and non-abusive head trauma groups. Discrepancy rates were compared for both groups. Lastly, primary interpretations and second interpretations were evaluated for discussion of imaging findings concerning for abusive head trauma. There were statistically significant differences between primary interpretation-second interpretation versus inter-reader overall and major discrepancy rates (28% vs. 6%, P=0.0001; 16% vs. 1%, P=0.0001). There were significant differences in the primary interpretation-second interpretation overall and major discrepancy rates for abusive head trauma patients compared to non-abusive head trauma

  19. Radiologic head CT interpretation errors in pediatric abusive and non-abusive head trauma patients

    Energy Technology Data Exchange (ETDEWEB)

    Kralik, Stephen F.; Finke, Whitney; Wu, Isaac C.; Ho, Chang Y. [Indiana University School of Medicine, Department of Radiology and Imaging Sciences, Indianapolis, IN (United States); Hibbard, Roberta A.; Hicks, Ralph A. [Indiana University School of Medicine, Department of Pediatrics, Section of Child Protection Programs, Indianapolis, IN (United States)

    2017-07-15

    Pediatric head trauma, including abusive head trauma, is a significant cause of morbidity and mortality. The purpose of this research was to identify and evaluate radiologic interpretation errors of head CTs performed on abusive and non-abusive pediatric head trauma patients from a community setting referred for a secondary interpretation at a tertiary pediatric hospital. A retrospective search identified 184 patients <5 years of age with head CT for known or potential head trauma who had a primary interpretation performed at a referring community hospital by a board-certified radiologist. Two board-certified fellowship-trained neuroradiologists at an academic pediatric hospital independently interpreted the head CTs, compared their interpretations to determine inter-reader discrepancy rates, and resolved discrepancies to establish a consensus second interpretation. The primary interpretation was compared to the consensus second interpretation using the RADPEER trademark scoring system to determine the primary interpretation-second interpretation overall and major discrepancy rates. MRI and/or surgical findings were used to validate the primary interpretation or second interpretation when possible. The diagnosis of abusive head trauma was made using clinical and imaging data by a child abuse specialist to separate patients into abusive head trauma and non-abusive head trauma groups. Discrepancy rates were compared for both groups. Lastly, primary interpretations and second interpretations were evaluated for discussion of imaging findings concerning for abusive head trauma. There were statistically significant differences between primary interpretation-second interpretation versus inter-reader overall and major discrepancy rates (28% vs. 6%, P=0.0001; 16% vs. 1%, P=0.0001). There were significant differences in the primary interpretation-second interpretation overall and major discrepancy rates for abusive head trauma patients compared to non-abusive head trauma

  20. Implication of spot position error on plan quality and patient safety in pencil-beam-scanning proton therapy

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Juan; Beltran, Chris J., E-mail: beltran.chris@mayo.edu; Herman, Michael G. [Division of Medical Physics, Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota 55905 (United States)

    2014-08-15

    Purpose: To quantitatively and systematically assess dosimetric effects induced by spot positioning error as a function of spot spacing (SS) on intensity-modulated proton therapy (IMPT) plan quality and to facilitate evaluation of safety tolerance limits on spot position. Methods: Spot position errors (PE) ranging from 1 to 2 mm were simulated. Simple plans were created on a water phantom, and IMPT plans were calculated on two pediatric patients with a brain tumor of 28 and 3 cc, respectively, using a commercial planning system. For the phantom, a uniform dose was delivered to targets located at different depths from 10 to 20 cm with various field sizes from 2{sup 2} to 15{sup 2} cm{sup 2}. Two nominal spot sizes, 4.0 and 6.6 mm of 1 σ in water at isocenter, were used for treatment planning. The SS ranged from 0.5 σ to 1.5 σ, which is 2–6 mm for the small spot size and 3.3–9.9 mm for the large spot size. Various perturbation scenarios of a single spot error and systematic and random multiple spot errors were studied. To quantify the dosimetric effects, percent dose error (PDE) depth profiles and the value of percent dose error at the maximum dose difference (PDE [ΔDmax]) were used for evaluation. Results: A pair of hot and cold spots was created per spot shift. PDE[ΔDmax] is found to be a complex function of PE, SS, spot size, depth, and global spot distribution that can be well defined in simple models. For volumetric targets, the PDE [ΔDmax] is not noticeably affected by the change of field size or target volume within the studied ranges. In general, reducing SS decreased the dose error. For the facility studied, given a single spot error with a PE of 1.2 mm and for both spot sizes, a SS of 1σ resulted in a 2% maximum dose error; a SS larger than 1.25 σ substantially increased the dose error and its sensitivity to PE. A similar trend was observed in multiple spot errors (both systematic and random errors). Systematic PE can lead to noticeable hot

  1. Prevention of prescription errors by computerized, on-line, individual patient related surveillance of drug order entry.

    Science.gov (United States)

    Oliven, A; Zalman, D; Shilankov, Y; Yeshurun, D; Odeh, M

    2002-01-01

    Computerized prescription of drugs is expected to reduce the number of many preventable drug ordering errors. In the present study we evaluated the usefullness of a computerized drug order entry (CDOE) system in reducing prescription errors. A department of internal medicine using a comprehensive CDOE, which included also patient-related drug-laboratory, drug-disease and drug-allergy on-line surveillance was compared to a similar department in which drug orders were handwritten. CDOE reduced prescription errors to 25-35%. The causes of errors remained similar, and most errors, on both departments, were associated with abnormal renal function and electrolyte balance. Residual errors remaining on the CDOE-using department were due to handwriting on the typed order, failure to feed patients' diseases, and system failures. The use of CDOE was associated with a significant reduction in mean hospital stay and in the number of changes performed in the prescription. The findings of this study both quantity the impact of comprehensive CDOE on prescription errors and delineate the causes for remaining errors.

  2. TH-B-BRC-00: How to Identify and Resolve Potential Clinical Errors Before They Impact Patients Treatment: Lessons Learned

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2016-06-15

    Radiation treatment consists of a chain of events influenced by the quality of machine operation, beam data commissioning, machine calibration, patient specific data, simulation, treatment planning, imaging and treatment delivery. There is always a chance that the clinical medical physicist may make or fail to detect an error in one of the events that may impact on the patient’s treatment. In the clinical scenario, errors may be systematic and, without peer review, may have a low detectability because they are not part of routine QA procedures. During treatment, there might be errors on machine that needs attention. External reviews of some of the treatment delivery components by independent reviewers, like IROC, can detect errors, but may not be timely. The goal of this session is to help junior clinical physicists identify potential errors as well as the approach of quality assurance to perform a root cause analysis to find and eliminate an error and to continually monitor for errors. A compilation of potential errors will be presented by examples of the thought process required to spot the error and determine the root cause. Examples may include unusual machine operation, erratic electrometer reading, consistent lower electron output, variation in photon output, body parts inadvertently left in beam, unusual treatment plan, poor normalization, hot spots etc. Awareness of the possibility and detection of error in any link of the treatment process chain will help improve the safe and accurate delivery of radiation to patients. Four experts will discuss how to identify errors in four areas of clinical treatment. D. Followill, NIH grant CA 180803.

  3. TH-B-BRC-00: How to Identify and Resolve Potential Clinical Errors Before They Impact Patients Treatment: Lessons Learned

    International Nuclear Information System (INIS)

    2016-01-01

    Radiation treatment consists of a chain of events influenced by the quality of machine operation, beam data commissioning, machine calibration, patient specific data, simulation, treatment planning, imaging and treatment delivery. There is always a chance that the clinical medical physicist may make or fail to detect an error in one of the events that may impact on the patient’s treatment. In the clinical scenario, errors may be systematic and, without peer review, may have a low detectability because they are not part of routine QA procedures. During treatment, there might be errors on machine that needs attention. External reviews of some of the treatment delivery components by independent reviewers, like IROC, can detect errors, but may not be timely. The goal of this session is to help junior clinical physicists identify potential errors as well as the approach of quality assurance to perform a root cause analysis to find and eliminate an error and to continually monitor for errors. A compilation of potential errors will be presented by examples of the thought process required to spot the error and determine the root cause. Examples may include unusual machine operation, erratic electrometer reading, consistent lower electron output, variation in photon output, body parts inadvertently left in beam, unusual treatment plan, poor normalization, hot spots etc. Awareness of the possibility and detection of error in any link of the treatment process chain will help improve the safe and accurate delivery of radiation to patients. Four experts will discuss how to identify errors in four areas of clinical treatment. D. Followill, NIH grant CA 180803

  4. The sensitivity of patient specific IMRT QC to systematic MLC leaf bank offset errors

    International Nuclear Information System (INIS)

    Rangel, Alejandra; Palte, Gesa; Dunscombe, Peter

    2010-01-01

    Purpose: Patient specific IMRT QC is performed routinely in many clinics as a safeguard against errors and inaccuracies which may be introduced during the complex planning, data transfer, and delivery phases of this type of treatment. The purpose of this work is to evaluate the feasibility of detecting systematic errors in MLC leaf bank position with patient specific checks. Methods: 9 head and neck (H and N) and 14 prostate IMRT beams were delivered using MLC files containing systematic offsets (±1 mm in two banks, ±0.5 mm in two banks, and 1 mm in one bank of leaves). The beams were measured using both MAPCHECK (Sun Nuclear Corp., Melbourne, FL) and the aS1000 electronic portal imaging device (Varian Medical Systems, Palo Alto, CA). Comparisons with calculated fields, without offsets, were made using commonly adopted criteria including absolute dose (AD) difference, relative dose difference, distance to agreement (DTA), and the gamma index. Results: The criteria most sensitive to systematic leaf bank offsets were the 3% AD, 3 mm DTA for MAPCHECK and the gamma index with 2% AD and 2 mm DTA for the EPID. The criterion based on the relative dose measurements was the least sensitive to MLC offsets. More highly modulated fields, i.e., H and N, showed greater changes in the percentage of passing points due to systematic MLC inaccuracy than prostate fields. Conclusions: None of the techniques or criteria tested is sufficiently sensitive, with the population of IMRT fields, to detect a systematic MLC offset at a clinically significant level on an individual field. Patient specific QC cannot, therefore, substitute for routine QC of the MLC itself.

  5. The sensitivity of patient specific IMRT QC to systematic MLC leaf bank offset errors

    Energy Technology Data Exchange (ETDEWEB)

    Rangel, Alejandra; Palte, Gesa; Dunscombe, Peter [Department of Medical Physics, Tom Baker Cancer Centre, 1331-29 Street NW, Calgary, Alberta T2N 4N2, Canada and Department of Physics and Astronomy, University of Calgary, 2500 University Drive North West, Calgary, Alberta T2N 1N4 (Canada); Department of Medical Physics, Tom Baker Cancer Centre, 1331-29 Street NW, Calgary, Alberta T2N 4N2 (Canada); Department of Medical Physics, Tom Baker Cancer Centre, 1331-29 Street NW, Calgary, Alberta T2N 4N2 (Canada); Department of Physics and Astronomy, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4 (Canada) and Department of Oncology, Tom Baker Cancer Centre, 1331-29 Street NW, Calgary, Alberta T2N 4N2 (Canada)

    2010-07-15

    Purpose: Patient specific IMRT QC is performed routinely in many clinics as a safeguard against errors and inaccuracies which may be introduced during the complex planning, data transfer, and delivery phases of this type of treatment. The purpose of this work is to evaluate the feasibility of detecting systematic errors in MLC leaf bank position with patient specific checks. Methods: 9 head and neck (H and N) and 14 prostate IMRT beams were delivered using MLC files containing systematic offsets ({+-}1 mm in two banks, {+-}0.5 mm in two banks, and 1 mm in one bank of leaves). The beams were measured using both MAPCHECK (Sun Nuclear Corp., Melbourne, FL) and the aS1000 electronic portal imaging device (Varian Medical Systems, Palo Alto, CA). Comparisons with calculated fields, without offsets, were made using commonly adopted criteria including absolute dose (AD) difference, relative dose difference, distance to agreement (DTA), and the gamma index. Results: The criteria most sensitive to systematic leaf bank offsets were the 3% AD, 3 mm DTA for MAPCHECK and the gamma index with 2% AD and 2 mm DTA for the EPID. The criterion based on the relative dose measurements was the least sensitive to MLC offsets. More highly modulated fields, i.e., H and N, showed greater changes in the percentage of passing points due to systematic MLC inaccuracy than prostate fields. Conclusions: None of the techniques or criteria tested is sufficiently sensitive, with the population of IMRT fields, to detect a systematic MLC offset at a clinically significant level on an individual field. Patient specific QC cannot, therefore, substitute for routine QC of the MLC itself.

  6. Dosimetric Changes Resulting From Patient Rotational Setup Errors in Proton Therapy Prostate Plans

    International Nuclear Information System (INIS)

    Sejpal, Samir V.; Amos, Richard A.; Bluett, Jaques B.; Levy, Lawrence B.; Kudchadker, Rajat J.; Johnson, Jennifer; Choi, Seungtaek; Lee, Andrew K.

    2009-01-01

    Purpose: To evaluate the dose changes to the target and critical structures from rotational setup errors in prostate cancer patients treated with proton therapy. Methods and Materials: A total of 70 plans were analyzed for 10 patients treated with parallel-opposed proton beams to a dose of 7,600 60 Co-cGy-equivalent (CcGE) in 200 CcGE fractions to the clinical target volume (i.e., prostate and proximal seminal vesicles). Rotational setup errors of +3 o , -3 deg., +5 deg., and -5 deg. (to simulate pelvic tilt) were generated by adjusting the gantry. Horizontal couch shifts of +3 deg. and -3 deg. (to simulate longitudinal setup variability) were also generated. Verification plans were recomputed, keeping the same treatment parameters as the control. Results: All changes shown are for 38 fractions. The mean clinical target volume dose was 7,780 CcGE. The mean change in the clinical target volume dose in the worse case scenario for all shifts was 2 CcGE (absolute range in worst case scenario, 7,729-7,848 CcGE). The mean changes in the critical organ dose in the worst case scenario was 6 CcGE (bladder), 18 CcGE (rectum), 36 CcGE (anterior rectal wall), and 141 CcGE (femoral heads) for all plans. In general, the percentage of change in the worse case scenario for all shifts to the critical structures was <5%. Deviations in the absolute percentage of volume of organ receiving 45 and 70 Gy for the bladder and rectum were <2% for all plans. Conclusion: Patient rotational movements of 3 deg. and 5 deg. and horizontal couch shifts of 3 deg. in prostate proton planning did not confer clinically significant dose changes to the target volumes or critical structures.

  7. Relationship Between Patients' Perceptions of Care Quality and Health Care Errors in 11 Countries: A Secondary Data Analysis.

    Science.gov (United States)

    Hincapie, Ana L; Slack, Marion; Malone, Daniel C; MacKinnon, Neil J; Warholak, Terri L

    2016-01-01

    Patients may be the most reliable reporters of some aspects of the health care process; their perspectives should be considered when pursuing changes to improve patient safety. The authors evaluated the association between patients' perceived health care quality and self-reported medical, medication, and laboratory errors in a multinational sample. The analysis was conducted using the 2010 Commonwealth Fund International Health Policy Survey, a multinational consumer survey conducted in 11 countries. Quality of care was measured by a multifaceted construct developed using Rasch techniques. After adjusting for potentially important confounding variables, an increase in respondents' perceptions of care coordination decreased the odds of self-reporting medical errors, medication errors, and laboratory errors (P < .001). As health care stakeholders continue to search for initiatives that improve care experiences and outcomes, this study's results emphasize the importance of guaranteeing integrated care.

  8. Comparison of community and hospital pharmacists' attitudes and behaviors on medication error disclosure to the patient: A pilot study.

    Science.gov (United States)

    Kim, ChungYun; Mazan, Jennifer L; Quiñones-Boex, Ana C

    To determine pharmacists' attitudes and behaviors on medication errors and their disclosure and to compare community and hospital pharmacists on such views. An online questionnaire was developed from previous studies on physicians' disclosure of errors. Questionnaire items included demographics, environment, personal experiences, and attitudes on medication errors and the disclosure process. An invitation to participate along with the link to the questionnaire was electronically distributed to members of two Illinois pharmacy associations. A follow-up reminder was sent 4 weeks after the original message. Data were collected for 3 months, and statistical analyses were performed with the use of IBM SPSS version 22.0. The overall response rate was 23.3% (n = 422). The average employed respondent was a 51-year-old white woman with a BS Pharmacy degree working in a hospital pharmacy as a clinical staff member. Regardless of practice settings, pharmacist respondents agreed that medication errors were inevitable and that a disclosure process is necessary. Respondents from community and hospital settings were further analyzed to assess any differences. Community pharmacist respondents were more likely to agree that medication errors were inevitable and that pharmacists should address the patient's emotions when disclosing an error. Community pharmacist respondents were also more likely to agree that the health care professional most closely involved with the error should disclose the error to the patient and thought that it was the pharmacists' responsibility to disclose the error. Hospital pharmacist respondents were more likely to agree that it was important to include all details in a disclosure process and more likely to disagree on putting a "positive spin" on the event. Regardless of practice setting, responding pharmacists generally agreed that errors should be disclosed to patients. There were, however, significant differences in their attitudes and behaviors

  9. Epidemiology of Adverse Events and Medical Errors in the Care of Cardiology Patients.

    Science.gov (United States)

    Ohta, Yoshinori; Miki, Izumi; Kimura, Takeshi; Abe, Mitsuru; Sakuma, Mio; Koike, Kaoru; Morimoto, Takeshi

    2016-11-02

    There have been epidemiological studies of adverse events (AEs) among general patients but those of patients cared by cardiologist are not well scrutinized. We investigated the occurrence of AEs and medical errors (MEs) among adult patients with cardiology in Japan. We conducted a cross-sectional study of adult outpatients at a Japanese teaching hospital from February through November 2006. We measured AE and ME incidents from patient report, which were verified by medical records, laboratory data, incident reports, and prescription queries. Two independent physicians reviewed the incidents to determine whether they were AEs or MEs and to assess severity and symptoms. We identified 144 AEs and 30 MEs (16.3 and 3.9 per 100 patients, respectively). Of the 144 AEs, 99 were solely adverse drug events (ADEs), 20 were solely non-ADEs, and the remaining 25 were both causes. The most frequent symptoms of ADEs were skin and allergic reactions due to medication. The most frequent symptoms of non-ADEs were bleeding due to therapeutic interventions. Among AEs, 12% was life threatening. Life-threatening AEs were 25% of non-ADEs and 5% of ADEs (P = 0.0003). Among the 30 MEs, 21MEs (70%) were associated with drugs. Adverse events were common among cardiology patients. Adverse drug events were the most frequent AEs, and non-ADEs were more critical than ADEs. Such data should be recognized among practicing physicians to improve the patients' outcomes.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

  10. Medication errors versus time of admission in a subpopulation of stroke patients undergoing inpatient rehabilitation complications and considerations.

    Science.gov (United States)

    Pitts, Eric P

    2011-01-01

    This study looked at the medication ordering error frequency and the length of inpatient hospital stay in a subpopulation of stroke patients (n-60) as a function of time of patient admission to an inpatient rehabilitation hospital service. A total of 60 inpatient rehabilitation patients, 30 arriving before 4 pm, and 30 arriving after 4 pm, with as admitting diagnosis of stroke were randomly selected from a larger sample (N=426). There was a statistically significant increase in medication ordering errors and the number of inpatient rehabilitation hospital days in the group of patients who arrived after 4 pm.

  11. A Case of Transfusion Error in a Trauma Patient With Subsequent Root Cause Analysis Leading to Institutional Change

    Directory of Open Access Journals (Sweden)

    Sean Patrick Clifford MD

    2016-05-01

    Full Text Available A 28-year-old man presented emergently to the operating room following a gun-shot injury to his right groin. Our hospital’s Massive Transfusion Protocol was initiated as the patient entered the operating room actively hemorrhaging and severely hypotensive. During the aggressive resuscitation efforts, the patient was inadvertently transfused 2 units of packed red blood cells intended for another patient due to a series of errors. Fortunately, the incorrect product was compatible, and the patient recovered from his near-fatal injuries. Root cause analysis was used to review the transfusion error and develop an action plan to help prevent future occurrences.

  12. A Case of Transfusion Error in a Trauma Patient With Subsequent Root Cause Analysis Leading to Institutional Change.

    Science.gov (United States)

    Clifford, Sean Patrick; Mick, Paul Brian; Derhake, Brian Matthew

    2016-01-01

    A 28-year-old man presented emergently to the operating room following a gun-shot injury to his right groin. Our hospital's Massive Transfusion Protocol was initiated as the patient entered the operating room actively hemorrhaging and severely hypotensive. During the aggressive resuscitation efforts, the patient was inadvertently transfused 2 units of packed red blood cells intended for another patient due to a series of errors. Fortunately, the incorrect product was compatible, and the patient recovered from his near-fatal injuries. Root cause analysis was used to review the transfusion error and develop an action plan to help prevent future occurrences.

  13. Patient safety in dentistry - state of play as revealed by a national database of errors.

    Science.gov (United States)

    Thusu, S; Panesar, S; Bedi, R

    2012-08-01

    Modern dentistry has become increasingly invasive and sophisticated. Consequently the risk to the patient has increased. The aim of this study is to investigate the types of patient safety incidents (PSIs) that occur in dentistry and the accuracy of the National Patient Safety Agency (NPSA) database in identifying those attributed to dentistry. The database was analysed for all incidents of iatrogenic harm in the speciality of dentistry. A snapshot view using the timeframe January to December 2009 was used. The free text elements from the database were analysed thematically and reclassified according to the nature of the PSI. Descriptive statistics were provided. Two thousand and twelve incident reports were analysed and organised into ten categories. The commonest was due to clerical errors - 36%. Five areas of PSI were further analysed: injury (10%), medical emergency (6%), inhalation/ingestion (4%), adverse reaction (4%) and wrong site extraction (2%). There is generally low reporting of PSIs within the dental specialities. This may be attributed to the voluntary nature of reporting and the reluctance of dental practitioners to disclose incidences for fear of loss of earnings. A significant amount of iatrogenic harm occurs not during treatment but through controllable pre- and post-procedural checks. Incidences of iatrogenic harm to dental patients do occur but their reporting is not widely used. The use of a dental specific reporting system would aid in minimising iatrogenic harm and adhere to the Care Quality Commission (CQC) compliance monitoring system on essential standards of quality and safety in dental practices.

  14. The surveillance error grid.

    Science.gov (United States)

    Klonoff, David C; Lias, Courtney; Vigersky, Robert; Clarke, William; Parkes, Joan Lee; Sacks, David B; Kirkman, M Sue; Kovatchev, Boris

    2014-07-01

    Currently used error grids for assessing clinical accuracy of blood glucose monitors are based on out-of-date medical practices. Error grids have not been widely embraced by regulatory agencies for clearance of monitors, but this type of tool could be useful for surveillance of the performance of cleared products. Diabetes Technology Society together with representatives from the Food and Drug Administration, the American Diabetes Association, the Endocrine Society, and the Association for the Advancement of Medical Instrumentation, and representatives of academia, industry, and government, have developed a new error grid, called the surveillance error grid (SEG) as a tool to assess the degree of clinical risk from inaccurate blood glucose (BG) monitors. A total of 206 diabetes clinicians were surveyed about the clinical risk of errors of measured BG levels by a monitor. The impact of such errors on 4 patient scenarios was surveyed. Each monitor/reference data pair was scored and color-coded on a graph per its average risk rating. Using modeled data representative of the accuracy of contemporary meters, the relationships between clinical risk and monitor error were calculated for the Clarke error grid (CEG), Parkes error grid (PEG), and SEG. SEG action boundaries were consistent across scenarios, regardless of whether the patient was type 1 or type 2 or using insulin or not. No significant differences were noted between responses of adult/pediatric or 4 types of clinicians. Although small specific differences in risk boundaries between US and non-US clinicians were noted, the panel felt they did not justify separate grids for these 2 types of clinicians. The data points of the SEG were classified in 15 zones according to their assigned level of risk, which allowed for comparisons with the classic CEG and PEG. Modeled glucose monitor data with realistic self-monitoring of blood glucose errors derived from meter testing experiments plotted on the SEG when compared to

  15. A Simulation Study on Patient Setup Errors in External Beam Radiotherapy Using an Anthropomorphic 4D Phantom

    Directory of Open Access Journals (Sweden)

    Payam Samadi Miandoab

    2016-12-01

    Full Text Available Introduction Patient set-up optimization is required in radiotherapy to fill the accuracy gap between personalized treatment planning and uncertainties in the irradiation set-up. In this study, we aimed to develop a new method based on neural network to estimate patient geometrical setup using 4-dimensional (4D XCAT anthropomorphic phantom. Materials and Methods To access 4D modeling of motion of dynamic organs, a phantom employs non-uniform rational B-splines (NURBS-based Cardiac-Torso method with spline-based model to generate 4D computed tomography (CT images. First, to generate all the possible roto-translation positions, the 4D CT images were imported to Medical Image Data Examiner (AMIDE. Then, for automatic, real time verification of geometrical setup, an artificial neural network (ANN was proposed to estimate patient displacement, using training sets. Moreover, three external motion markers were synchronized with a patient couch position as reference points. In addition, the technique was validated through simulated activities by using reference 4D CT data acquired from five patients. Results The results indicated that patient geometrical set-up is highly depended on the comprehensiveness of training set. By using ANN model, the average patient setup error in XCAT phantom was reduced from 17.26 mm to 0.50 mm. In addition, in the five real patients, these average errors were decreased from 18.26 mm to 1.48 mm various breathing phases ranging from inhalation to exhalation were taken into account for patient setup. Uncertainty error assessment and different setup errors were obtained from each respiration phase. Conclusion This study proposed a new method for alignment of patient setup error using ANN model. Additionally, our correlation model (ANN could estimate true patient position with less error.

  16. System care improves trauma outcome: patient care errors dominate reduced preventable death rate.

    Science.gov (United States)

    Thoburn, E; Norris, P; Flores, R; Goode, S; Rodriguez, E; Adams, V; Campbell, S; Albrink, M; Rosemurgy, A

    1993-01-01

    A review of 452 trauma deaths in Hillsborough County, Florida, in 1984 documented that 23% of non-CNS trauma deaths were preventable and occurred because of inadequate resuscitation or delay in proper surgical care. In late 1988 Hillsborough County organized a County Trauma Agency (HCTA) to coordinate trauma care among prehospital providers and state-designated trauma centers. The purpose of this study was to review county trauma deaths after the inception of the HCTA to determine the frequency of preventable deaths. 504 trauma deaths occurring between October 1989 and April 1991 were reviewed. Through committee review, 10 deaths were deemed preventable; 2 occurred outside the trauma system. Of the 10 deaths, 5 preventable deaths occurred late in severely injured patients. The preventable death rate has decreased to 7.0% with system care. The causes of preventable deaths have changed from delayed or inadequate intervention to postoperative care errors.

  17. When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient-doctor relationship.

    Science.gov (United States)

    Bell, Sigall K; Mejilla, Roanne; Anselmo, Melissa; Darer, Jonathan D; Elmore, Joann G; Leveille, Suzanne; Ngo, Long; Ralston, James D; Delbanco, Tom; Walker, Jan

    2017-04-01

    Patient advocates and safety experts encourage adoption of transparent health records, but sceptics worry that shared notes may offend patients, erode trust or promote defensive medicine. As electronic health records disseminate, such disparate views fuel policy debates about risks and benefits of sharing visit notes with patients through portals. Presurveys and postsurveys from 99 volunteer doctors at three US sites who participated in OpenNotes and postsurveys from 4592 patients who read at least one note and submitted a survey. Patients read notes to be better informed and because they were curious; about a third read them to check accuracy. In total, 7% (331) of patients reported contacting their doctor's office about their note. Of these, 29% perceived an error, and 85% were satisfied with its resolution. Nearly all patients reported feeling better (37%) or the same (62%) about their doctor. Patients who were older (>63), male, non-white, had fair/poor self-reported health or had less formal education were more likely to report feeling better about their doctor. Among doctors, 26% anticipated documentation errors, and 44% thought patients would disagree with notes. After a year, 53% believed patient satisfaction increased, and 51% thought patients trusted them more. None reported ordering more tests or referrals. Despite concerns about errors, offending language or defensive practice, transparent notes overall did not harm the patient-doctor relationship. Rather, doctors and patients perceived relational benefits. Traditionally more vulnerable populations-non-white, those with poorer self-reported health and those with fewer years of formal education-may be particularly likely to feel better about their doctor after reading their notes. Further informing debate about OpenNotes, the findings suggest transparent records may improve patient satisfaction, trust and safety. Published by the BMJ Publishing Group Limited. For permission to use (where not already

  18. [Measures to prevent patient identification errors in blood collection/physiological function testing utilizing a laboratory information system].

    Science.gov (United States)

    Shimazu, Chisato; Hoshino, Satoshi; Furukawa, Taiji

    2013-08-01

    We constructed an integrated personal identification workflow chart using both bar code reading and an all in-one laboratory information system. The information system not only handles test data but also the information needed for patient guidance in the laboratory department. The reception terminals at the entrance, displays for patient guidance and patient identification tools at blood-sampling booths are all controlled by the information system. The number of patient identification errors was greatly reduced by the system. However, identification errors have not been abolished in the ultrasound department. After re-evaluation of the patient identification process in this department, we recognized that the major reason for the errors came from excessive identification workflow. Ordinarily, an ultrasound test requires patient identification 3 times, because 3 different systems are required during the entire test process, i.e. ultrasound modality system, laboratory information system and a system for producing reports. We are trying to connect the 3 different systems to develop a one-time identification workflow, but it is not a simple task and has not been completed yet. Utilization of the laboratory information system is effective, but is not yet perfect for patient identification. The most fundamental procedure for patient identification is to ask a person's name even today. Everyday checks in the ordinary workflow and everyone's participation in safety-management activity are important for the prevention of patient identification errors.

  19. TECHNOLOGY VS NATURE: HUMAN ERROR IN DEALING WITH NATURE IN CRICHTON'S JURASSIC PARK

    Directory of Open Access Journals (Sweden)

    Sarah Prasasti

    2000-01-01

    Full Text Available Witnessing the euphoria of the era of biotechnology in the late twentieth century, Crichton exposes the theme of biotechnology in his works. In Jurassic Park, he voices his concern about the impact of the use of biotechnology to preserve nature and its living creatures. He further describes how the purpose of preserving nature and the creatures has turned out to be destructive. This article discusses Crichton's main character, Hammond, who attempts to control nature by genetically recreating the extinct fossil animals. It seems that the attempt ignores his human limitations. Although he is confident that has been equipped with the technology, he forgets to get along with nature. His way of using technology to accomplish his purpose proves not to be in harmony with nature. As a consequence, nature fights back. And he is conquered.

  20. Information System Hazard Analysis: A Method for Identifying Technology-induced Latent Errors for Safety.

    Science.gov (United States)

    Weber, Jens H; Mason-Blakley, Fieran; Price, Morgan

    2015-01-01

    Many health information and communication technologies (ICT) are safety-critical; moreover, reports of technology-induced adverse events related to them are plentiful in the literature. Despite repeated criticism and calls to action, recent data collected by the Institute of Medicine (IOM) and other organization do not indicate significant improvements with respect to the safety of health ICT systems. A large part of the industry still operates on a reactive "break & patch" model; the application of pro-active, systematic hazard analysis methods for engineering ICT that produce "safe by design" products is sparse. This paper applies one such method: Information System Hazard Analysis (ISHA). ISHA adapts and combines hazard analysis techniques from other safety-critical domains and customizes them for ICT. We provide an overview of the steps involved in ISHA and describe.

  1. DISTURBANCE ERROR INVARIANCE IN AUTOMATIC CONTROL SYSTEMS FOR TECHNOLOGICAL OBJECT TRAJECTORY MOVEMENT

    Directory of Open Access Journals (Sweden)

    A. V. Lekareva

    2016-09-01

    Full Text Available We consider combined control in automatic control systems for technological objects trajectory movements. We present research results of the system disturbance invariance ensuring on the example of the technological manipulator that implements hydrocutting of the oil pipelines. Control is based on the propositions of the fourth modified invariance form with the use of bootstrapping methods. The paper presents analysis of results obtained by two different correction methods. The essence of the first method lies in injection of additional component into the already established control signal and formation of the channel for that component. Control signal correction during the signal synthesis stage in the control device constitutes the basis for the second method. Research results have shown high efficiency of application for both correction methods. Both methods have roughly the same precision. We have shown that the correction in the control device is preferable because it has no influence on the inner contour of the system. We have shown the necessity of the block usage with the variable transmission coefficient, which value is determined by technological trajectory parameters. Research results can be applied in practice for improvement of the precision specifications of automatic control systems for trajectorial manipulators.

  2. Overview of the LARES Mission: orbit, error analysis and technological aspects

    International Nuclear Information System (INIS)

    Ciufolini, Ignazio; Paolozzi, Antonio; Paris, Claudio

    2012-01-01

    LARES (LAser RElativity Satellite), is an Italian Space Agency (ASI) mission to be launched beginning of 2012 with the new European launch vehicle, VEGA; the launch opportunity was provided by the European Space Agency (ESA). LARES is a laser ranged satellite; it will be launched into a nearly circular orbit, with an altitude of 1450 km and an inclination of 69.5 degrees. The goal of the mission is the measurement of the Lense-Thirring effect with an uncertainty of few percent; such a small uncertainty will be achieved using LARES data together with data from the LAGEOS I (NASA) and LAGEOS II (NASA and ASI) satellites, and because GRACE mission (NASA-CSR and DLR-GFZ) is improving Earth's gravity field models. This paper describes LARES experiment along with the principal error sources affecting the measurement. Furthermore, some engineering aspects of the mission, in particular the structure and materials of the satellite (designed in order to minimize the non-gravitational perturbations), are described.

  3. [Patient safety culture based on a non-punitive response to error and freedom of expression of healthcare professionals].

    Science.gov (United States)

    Mahjoub, Mohamed; Bouafia, Nabiha; Cheikh, Asma Ben; Ezzi, Olfa; Njah, Mansour

    2016-11-25

    This study provided an overview of healthcare professionals’ perception of patient safety based on analysis of the concept of freedom of expression and non-punitive response in order to identify and correct errors in our health system. This concept is a cornerstone of the patient safety culture among healthcare professionals and plays a central role in the quality improvement strategy..

  4. Route learning in amnesia: a comparison of trial-and-error and errorless learning in patients with the Korsakoff syndrome.

    Science.gov (United States)

    Kessels, Roy P C; van Loon, Eke; Wester, Arie J

    2007-10-01

    To examine the errorless learning approach using a procedural memory task (i.e. learning of actual routes) in patients with amnesia, as compared to trial-and-error learning. Counterbalanced self-controlled cases series. Psychiatric hospital (Korsakoff clinic). A convenience sample of 10 patients with the Korsakoff amnestic syndrome. All patients learned a route in four sessions on separate days using an errorless approach and a different route using trial-and-error. Error rate was scored during route learning and standard neuro-psychological tests were administered (i.e. subtest route recall of the Rivermead Behavioural Memory Test (RBMT) and the Dutch version of the California Verbal Learning Test (VLGT)). A significant learning effect was found in the trial-and-error condition over consecutive sessions (P = 0.006), but no performance difference was found between errorless and trial-and-error learning of the routes. VLGT performance was significantly correlated with a trial-and-error advantage (P Korsakoff syndrome (severe amnesia).

  5. Intricacies and strategies for the implementation of new technologies in radiotherapy: Reflections on the meaning and prevention of the error

    Science.gov (United States)

    Espejo-Villalobos, J. D.; Franco-Cabrera, M. C.; Estrada-Hernandez, C.; Quintero-Castelan, M. S.

    2012-10-01

    When facing the challenge of implementing new technologies in Radiotherapy, a reflection on philosophical and ethical principles is in order for the Medical Physicist to assume a reality of increased risks of harm to the patient. A series of ideas from philosophers and clinical professionals are reviewed to encourage an increased awareness of our ethical responsibility towards patients that entrust us with their hopes for alleviating their disease.

  6. Intricacies and strategies for the implementation of new technologies in radiotherapy: Reflections on the meaning and prevention of the error

    International Nuclear Information System (INIS)

    Espejo-Villalobos, J. D.; Franco-Cabrera, M. C.; Estrada-Hernandez, C.; Quintero-Castelan, M. S.

    2012-01-01

    When facing the challenge of implementing new technologies in Radiotherapy, a reflection on philosophical and ethical principles is in order for the Medical Physicist to assume a reality of increased risks of harm to the patient. A series of ideas from philosophers and clinical professionals are reviewed to encourage an increased awareness of our ethical responsibility towards patients that entrust us with their hopes for alleviating their disease.

  7. Intricacies and strategies for the implementation of new technologies in radiotherapy: Reflections on the meaning and prevention of the error

    Energy Technology Data Exchange (ETDEWEB)

    Espejo-Villalobos, J. D.; Franco-Cabrera, M. C.; Estrada-Hernandez, C.; Quintero-Castelan, M. S. [Centro Medico Hospital San Jose -TEC Salud, Department of Radiothrapy. Av. Ignacio Morones Prieto 3000 Pte. Col. Los Doctores, Monterrey, Nuevo Leon, 64710 (Mexico)

    2012-10-23

    When facing the challenge of implementing new technologies in Radiotherapy, a reflection on philosophical and ethical principles is in order for the Medical Physicist to assume a reality of increased risks of harm to the patient. A series of ideas from philosophers and clinical professionals are reviewed to encourage an increased awareness of our ethical responsibility towards patients that entrust us with their hopes for alleviating their disease.

  8. Is a shift from research on individual medical error to research on health information technology underway? A 40-year analysis of publication trends in medical journals.

    Science.gov (United States)

    Erlewein, Daniel; Bruni, Tommaso; Gadebusch Bondio, Mariacarla

    2018-06-07

    In 1983, McIntyre and Popper underscored the need for more openness in dealing with errors in medicine. Since then, much has been written on individual medical errors. Furthermore, at the beginning of the 21st century, researchers and medical practitioners increasingly approached individual medical errors through health information technology. Hence, the question arises whether the attention of biomedical researchers shifted from individual medical errors to health information technology. We ran a study to determine publication trends concerning individual medical errors and health information technology in medical journals over the last 40 years. We used the Medical Subject Headings (MeSH) taxonomy in the database MEDLINE. Each year, we analyzed the percentage of relevant publications to the total number of publications in MEDLINE. The trends identified were tested for statistical significance. Our analysis showed that the percentage of publications dealing with individual medical errors increased from 1976 until the beginning of the 21st century but began to drop in 2003. Both the upward and the downward trends were statistically significant (P information technology doubled between 2003 and 2015. The upward trend was statistically significant (P information technology in the USA and the UK. © 2018 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.

  9. [Medication reconciliation errors according to patient risk and type of physician prescriber identified by prescribing tool used].

    Science.gov (United States)

    Bilbao Gómez-Martino, Cristina; Nieto Sánchez, Ángel; Fernández Pérez, Cristina; Borrego Hernando, Mª Isabel; Martín-Sánchez, Francisco Javier

    2017-01-01

    To study the frequency of medication reconciliation errors (MREs) in hospitalized patients and explore the profiles of patients at greater risk. To compare the rates of errors in prescriptions written by emergency physicians and ward physicians, who each used a different prescribing tool. Prospective cross-sectional study of a convenience sample of patients admitted to medical, geriatric, and oncology wards over a period of 6 months. A pharmacist undertook the medication reconciliation report, and data were analyzed for possible associations with risk factors or prescriber type (emergency vs ward physician). A total of 148 patients were studied. Emergency physicians had prescribed for 68 (45.9%) and ward physicians for 80 (54.1%). A total of 303 MREs were detected; 113 (76.4%) patients had at least 1 error. No statistically significant differences were found between prescriber types. Factors that conferred risk for a medication error were use polypharmacy (odds ratio [OR], 3.4; 95% CI, 1.2-9.0; P=.016) and multiple chronic conditions in patients under the age of 80 years (OR, 3.9; 95% CI, 1.1-14.7; P=.039). The incidence of MREs is high regardless of whether the prescriber is an emergency or ward physician. The patients who are most at risk are those taking several medications and those under the age of 80 years who have multiple chronic conditions.

  10. Medication errors: an overview for clinicians.

    Science.gov (United States)

    Wittich, Christopher M; Burkle, Christopher M; Lanier, William L

    2014-08-01

    Medication error is an important cause of patient morbidity and mortality, yet it can be a confusing and underappreciated concept. This article provides a review for practicing physicians that focuses on medication error (1) terminology and definitions, (2) incidence, (3) risk factors, (4) avoidance strategies, and (5) disclosure and legal consequences. A medication error is any error that occurs at any point in the medication use process. It has been estimated by the Institute of Medicine that medication errors cause 1 of 131 outpatient and 1 of 854 inpatient deaths. Medication factors (eg, similar sounding names, low therapeutic index), patient factors (eg, poor renal or hepatic function, impaired cognition, polypharmacy), and health care professional factors (eg, use of abbreviations in prescriptions and other communications, cognitive biases) can precipitate medication errors. Consequences faced by physicians after medication errors can include loss of patient trust, civil actions, criminal charges, and medical board discipline. Methods to prevent medication errors from occurring (eg, use of information technology, better drug labeling, and medication reconciliation) have been used with varying success. When an error is discovered, patients expect disclosure that is timely, given in person, and accompanied with an apology and communication of efforts to prevent future errors. Learning more about medication errors may enhance health care professionals' ability to provide safe care to their patients. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  11. A technology-enhanced patient case workshop.

    Science.gov (United States)

    Pai, Vinita B; Kelley, Katherine A; Bellebaum, Katherine L

    2009-08-28

    To assess the impact of technology-based changes on student learning, skill development, and satisfaction in a patient-case workshop. A new workshop format for a course was adopted over a 3-year period. Students received and completed patient cases and obtained immediate performance feedback in class instead of preparing the case prior to class and waiting for instructors to grade and return their cases. The cases were designed and accessed via an online course management system. Student satisfaction was measured using end-of-course surveys. The impact of the technology-based changes on student learning, problem-solving, and critical-thinking skills was measured and compared between the 2 different course formats by assessing changes in examination responses. Three advantages to the new format were reported: real-life format in terms of time constraint for responses, a team learning environment, and expedient grading and feedback. Students overwhelmingly agreed that the new format should be continued. Students' examination scores improved significantly under the new format. The change in delivery of patient-case workshops to an online, real-time system was well accepted and resulted in enhanced learning, critical thinking, and problem-solving skills.

  12. Film techniques in radiotherapy for treatment verification, determination of patient exit dose, and detection of localization error

    International Nuclear Information System (INIS)

    Haus, A.G.; Marks, J.E.

    1974-01-01

    In patient radiation therapy, it is important to know that the diseased area is included in the treatment field and that normal anatomy is properly shielded or excluded. Since 1969, a film technique developed for imaging of the complete patient radiation exposure has been applied for treatment verification and for the detection and evaluation of localization errors that may occur during treatment. The technique basically consists of placing a film under the patient during the entire radiation exposure. This film should have proper sensitivity and contrast in the exit dose exposure range encountered in radiotherapy. In this communication, we describe how various exit doses fit the characteristic curve of the film; examples of films exposed to various exit doses; the technique for using the film to determine the spatial distribution of the absorbed exit dose; and types of errors commonly detected. Results are presented illustrating that, as the frequency of use of this film technique is increased, localization error is reduced significantly

  13. [The effectiveness of error reporting promoting strategy on nurse's attitude, patient safety culture, intention to report and reporting rate].

    Science.gov (United States)

    Kim, Myoungsoo

    2010-04-01

    The purpose of this study was to examine the impact of strategies to promote reporting of errors on nurses' attitude to reporting errors, organizational culture related to patient safety, intention to report and reporting rate in hospital nurses. A nonequivalent control group non-synchronized design was used for this study. The program was developed and then administered to the experimental group for 12 weeks. Data were analyzed using descriptive analysis, X(2)-test, t-test, and ANCOVA with the SPSS 12.0 program. After the intervention, the experimental group showed significantly higher scores for nurses' attitude to reporting errors (experimental: 20.73 vs control: 20.52, F=5.483, p=.021) and reporting rate (experimental: 3.40 vs control: 1.33, F=1998.083, porganizational culture and intention to report. The study findings indicate that strategies that promote reporting of errors play an important role in producing positive attitudes to reporting errors and improving behavior of reporting. Further advanced strategies for reporting errors that can lead to improved patient safety should be developed and applied in a broad range of hospitals.

  14. Uncertainties in HTGR neutron-physical characteristics due to computational errors and technological tolerances

    International Nuclear Information System (INIS)

    Glushkov, E.S.; Grebennik, V.N.; Davidenko, V.G.; Kosovskij, V.G.; Smirnov, O.N.; Tsibul'skij, V.F.

    1991-01-01

    The paper is dedicated to the consideration of uncertainties is neutron-physical characteristics (NPC) of high-temperature gas-cooled reactors (HTGR) with a core as spherical fuel element bed, which are caused by calculations from HTGR parameters mean values affecting NPC. Among NPC are: effective multiplication factor, burnup depth, reactivity effect, control element worth, distribution of neutrons and heat release over a reactor core, etc. The short description of calculated methods and codes used for HTGR calculations in the USSR is given and evaluations of NPC uncertainties of the methodical character are presented. Besides, the analysis of the effect technological deviations in parameters of reactor main elements such as uranium amount in the spherical fuel element, number of neutron-absorbing impurities in the reactor core and reflector, etc, upon the NPC is carried out. Results of some experimental studies of NPC of critical assemblies with graphite moderator are given as applied to HTGR. The comparison of calculations results and experiments on critical assemblies has made it possible to evaluate uncertainties of calculated description of HTGR NPC. (author). 8 refs, 8 figs, 6 tabs

  15. Assessment of residual error for online cone-beam CT-guided treatment of prostate cancer patients

    International Nuclear Information System (INIS)

    Letourneau, Daniel; Martinez, Alvaro A.; Lockman, David; Yan Di; Vargas, Carlos; Ivaldi, Giovanni; Wong, John

    2005-01-01

    Purpose: Kilovoltage cone-beam CT (CBCT) implemented on board a medical accelerator is available for image-guidance applications in our clinic. The objective of this work was to assess the magnitude and stability of the residual setup error associated with CBCT online-guided prostate cancer patient setup. Residual error pertains to the uncertainty in image registration, the limited mechanical accuracy, and the intrafraction motion during imaging and treatment. Methods and Materials: The residual error for CBCT online-guided correction was first determined in a phantom study. After online correction, the phantom residual error was determined by comparing megavoltage portal images acquired every 90 deg. to the corresponding digitally reconstructed radiographs. In the clinical study, 8 prostate cancer patients were implanted with three radiopaque markers made of high-winding coils. After positioning the patient using the skin marks, a CBCT scan was acquired and the setup error determined by fusing the coils on the CBCT and planning CT scans. The patient setup was then corrected by moving the couch accordingly. A second CBCT scan was acquired immediately after the correction to evaluate the residual target setup error. Intrafraction motion was evaluated by tracking the coils and the bony landmarks on kilovoltage radiographs acquired every 30 s between the two CBCT scans. Corrections based on soft-tissue registration were evaluated offline by aligning the prostate contours defined on both planning CT and CBCT images. Results: For ideal rigid phantoms, CBCT image-guided treatment can usually achieve setup accuracy of 1 mm or better. For the patients, after CBCT correction, the target setup error was reduced in almost all cases and was generally within ±1.5 mm. The image guidance process took 23-35 min, dictated by the computer speed and network configuration. The contribution of the intrafraction motion to the residual setup error was small, with a standard deviation of

  16. Ventilator Technologies Sustain Critically Injured Patients

    Science.gov (United States)

    2012-01-01

    Consider this scenario: A soldier has been critically wounded in a sudden firefight in a remote region of Afghanistan. The soldier s comrades attend to him and radio for help, but the soldier needs immediate medical expertise and treatment that is currently miles away. The connection between medical support for soldiers on the battlefield and astronauts in space may not be immediately obvious. But when it comes to providing adequate critical care, NASA and the military have very similar operational challenges, says Shannon Melton of NASA contractor Wyle Integrated Science and Engineering. Melton works within Johnson Space Center s Space Medicine Division, which supports astronaut crew health before, during, and after flight. In space, we have a limited number of care providers, and those providers are not always clinicians with extensive medical training. We have limited room to provide care, limited consumables, and our environment is not like that of a hospital, she says. The Space Medicine Division s Advanced Projects Group works on combining the expertise of both clinicians and engineers to develop new capabilities that address the challenges of medical support in space, including providing care to distant patients. This field, called telemedicine, blends advanced communications practices and technologies with innovative medical devices and techniques to allow caregivers with limited or no medical experience to support a patient s needs. NASA, just by its nature, has been doing remote medicine since the beginning of the Space Program, says Melton, an engineer in the Advanced Projects Group. Since part of NASA s mandate is to transfer the results of its technological innovation for the benefit of the public, the Agency has worked with doctors and private industry to find ways to apply the benefits of space medicine on Earth. In one such case, a NASA partnership has resulted in new technologies that may improve the quality of emergency medicine for wounded

  17. Response to "Improving Patient Safety With Error Identification in Chemotherapy Orders by Verification Nurses"
.

    Science.gov (United States)

    Zhu, Ling-Ling; Lv, Na; Zhou, Quan

    2016-12-01

    We read, with great interest, the study by Baldwin and Rodriguez (2016), which described the role of the verification nurse and details the verification process in identifying errors related to chemotherapy orders. We strongly agree with their findings that a verification nurse, collaborating closely with the prescribing physician, pharmacist, and treating nurse, can better identify errors and maintain safety during chemotherapy administration.

  18. A multiobserver study of the effects of including point-of-care patient photographs with portable radiography: a means to detect wrong-patient errors.

    Science.gov (United States)

    Tridandapani, Srini; Ramamurthy, Senthil; Provenzale, James; Obuchowski, Nancy A; Evanoff, Michael G; Bhatti, Pamela

    2014-08-01

    To evaluate whether the presence of facial photographs obtained at the point-of-care of portable radiography leads to increased detection of wrong-patient errors. In this institutional review board-approved study, 166 radiograph-photograph combinations were obtained from 30 patients. Consecutive radiographs from the same patients resulted in 83 unique pairs (ie, a new radiograph and prior, comparison radiograph) for interpretation. To simulate wrong-patient errors, mismatched pairs were generated by pairing radiographs from different patients chosen randomly from the sample. Ninety radiologists each interpreted a unique randomly chosen set of 10 radiographic pairs, containing up to 10% mismatches (ie, error pairs). Radiologists were randomly assigned to interpret radiographs with or without photographs. The number of mismatches was identified, and interpretation times were recorded. Ninety radiologists with 21 ± 10 (mean ± standard deviation) years of experience were recruited to participate in this observer study. With the introduction of photographs, the proportion of errors detected increased from 31% (9 of 29) to 77% (23 of 30; P = .006). The odds ratio for detection of error with photographs to detection without photographs was 7.3 (95% confidence interval: 2.29-23.18). Observer qualifications, training, or practice in cardiothoracic radiology did not influence sensitivity for error detection. There is no significant difference in interpretation time for studies without photographs and those with photographs (60 ± 22 vs. 61 ± 25 seconds; P = .77). In this observer study, facial photographs obtained simultaneously with portable chest radiographs increased the identification of any wrong-patient errors, without substantial increase in interpretation time. This technique offers a potential means to increase patient safety through correct patient identification. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

  19. Thresholds for human detection of patient setup errors in digitally reconstructed portal images of prostate fields

    International Nuclear Information System (INIS)

    Phillips, Brooke L.; Jiroutek, Michael R.; Tracton, Gregg; Elfervig, Michelle; Muller, Keith E.; Chaney, Edward L.

    2002-01-01

    Purpose: Computer-assisted methods to analyze electronic portal images for the presence of treatment setup errors should be studied in controlled experiments before use in the clinical setting. Validation experiments using images that contain known errors usually report the smallest errors that can be detected by the image analysis algorithm. This paper offers human error-detection thresholds as one benchmark for evaluating the smallest errors detected by algorithms. Unfortunately, reliable data are lacking describing human performance. The most rigorous benchmarks for human performance are obtained under conditions that favor error detection. To establish such benchmarks, controlled observer studies were carried out to determine the thresholds of detectability for in-plane and out-of-plane translation and rotation setup errors introduced into digitally reconstructed portal radiographs (DRPRs) of prostate fields. Methods and Materials: Seventeen observers comprising radiation oncologists, radiation oncology residents, physicists, and therapy students participated in a two-alternative forced choice experiment involving 378 DRPRs computed using the National Library of Medicine Visible Human data sets. An observer viewed three images at a time displayed on adjacent computer monitors. Each image triplet included a reference digitally reconstructed radiograph displayed on the central monitor and two DRPRs displayed on the flanking monitors. One DRPR was error free. The other DRPR contained a known in-plane or out-of-plane error in the placement of the treatment field over a target region in the pelvis. The range for each type of error was determined from pilot observer studies based on a Probit model for error detection. The smallest errors approached the limit of human visual capability. The observer was told what kind of error was introduced, and was asked to choose the DRPR that contained the error. Observer decisions were recorded and analyzed using repeated

  20.  Patient safety in orthopedic surgery: prioritizing key areas of iatrogenic harm through an analysis of 48,095 incidents reported to a national database of errors

    Directory of Open Access Journals (Sweden)

    Panesar SS

    2013-03-01

    Full Text Available  Sukhmeet S Panesar,1 Andrew Carson-Stevens,2 Sarah A Salvilla,1 Bhavesh Patel,3 Saqeb B Mirza,4 Bhupinder Mann51Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK; 2Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK; 3National Patient Safety Agency, London, UK; 4Department of Trauma and Orthopaedic Surgery, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, Hampshire, UK; 5Buckinghamshire Healthcare NHS Trust, Stoke Mandeville Hospital, Aylesbury, UKBackground: With scientific and technological advances, the practice of orthopedic surgery has transformed the lives of millions worldwide. Such successes however have a downside; not only is the provision of comprehensive orthopedic care becoming a fiscal challenge to policy-makers and funders, concerns are also being raised about the extent of the associated iatrogenic harm. The National Reporting and Learning System (NRLS in England and Wales is an underused resource which collects intelligence from reports about health care error.Methods: Using methods akin to case-control methodology, we have identified a method of prioritizing the areas of a national database of errors that have the greatest propensity for harm. Our findings are presented using odds ratios (ORs and 95% confidence intervals (CIs.Results: The largest proportion of surgical patient safety incidents reported to the NRLS was from the trauma and orthopedics specialty, 48,095/163,595 (29.4%. Of those, 14,482/48,095 (30.1% resulted in iatrogenic harm to the patient and 71/48,095 (0.15% resulted in death. The leading types of errors associated with harm involved the implementation of care and on-going monitoring (OR 5.94, 95% CI 5.53, 6.38; self-harming behavior of patients in hospitals (OR 2.14, 95% CI 1.45, 3.18; and infection control (OR 1.91, 95% CI 1.69, 2.17. We analyze these data to quantify the extent and type of iatrogenic

  1. Information technology-based approaches to reducing repeat drug exposure in patients with known drug allergies.

    Science.gov (United States)

    Cresswell, Kathrin M; Sheikh, Aziz

    2008-05-01

    There is increasing interest internationally in ways of reducing the high disease burden resulting from errors in medicine management. Repeat exposure to drugs to which patients have a known allergy has been a repeatedly identified error, often with disastrous consequences. Drug allergies are immunologically mediated reactions that are characterized by specificity and recurrence on reexposure. These repeat reactions should therefore be preventable. We argue that there is insufficient attention being paid to studying and implementing system-based approaches to reducing the risk of such accidental reexposure. Drawing on recent and ongoing research, we discuss a number of information technology-based interventions that can be used to reduce the risk of recurrent exposure. Proven to be effective in this respect are interventions that provide real-time clinical decision support; also promising are interventions aiming to enhance patient recognition, such as bar coding, radiofrequency identification, and biometric technologies.

  2. Beyond usability: designing effective technology implementation systems to promote patient safety.

    Science.gov (United States)

    Karsh, B-T

    2004-10-01

    Evidence is emerging that certain technologies such as computerized provider order entry may reduce the likelihood of patient harm. However, many technologies that should reduce medical errors have been abandoned because of problems with their design, their impact on workflow, and general dissatisfaction with them by end users. Patient safety researchers have therefore looked to human factors engineering for guidance on how to design technologies to be usable (easy to use) and useful (improving job performance, efficiency, and/or quality). While this is a necessary step towards improving the likelihood of end user satisfaction, it is still not sufficient. Human factors engineering research has shown that the manner in which technologies are implemented also needs to be designed carefully if benefits are to be realized. This paper reviews the theoretical knowledge on what leads to successful technology implementation and how this can be translated into specifically designed processes for successful technology change. The literature on diffusion of innovations, technology acceptance, organisational justice, participative decision making, and organisational change is reviewed and strategies for promoting successful implementation are provided. Given the rapid and ever increasing pace of technology implementation in health care, it is critical for the science of technology implementation to be understood and incorporated into efforts to improve patient safety.

  3. Error in laboratory report data for platelet count assessment in patients suspicious for dengue: a note from observation

    Directory of Open Access Journals (Sweden)

    Somsri Wiwanitkit

    2016-08-01

    Full Text Available Dengue is a common tropical infection that is still a global health threat. An important laboratory parameter for the management of dengue is platelet count. Platelet count is an useful test for diagnosis and following up on dengue. However, errors in laboratory reports can occur. This study is a retrospective analysis on laboratory report data of complete blood count in cases with suspicious dengue in a medical center within 1 month period during the outbreak season on October, 2015. According to the studied period, there were 184 requests for complete blood count for cases suspected for dengue. From those 184 laboratory report records, errors can be seen in 12 reports (6.5%. This study demonstrates that there are considerable high rate of post-analytical errors in laboratory reports. Interestingly, the platelet count in those erroneous reports can be unreliable and ineffective or problematic when it is used for the management of dengue suspicious patients.

  4. Detection of patient setup errors with a portal image - DRR registration software application.

    Science.gov (United States)

    Sutherland, Kenneth; Ishikawa, Masayori; Bengua, Gerard; Ito, Yoichi M; Miyamoto, Yoshiko; Shirato, Hiroki

    2011-02-18

    The purpose of this study was to evaluate a custom portal image - digitally reconstructed radiograph (DRR) registration software application. The software works by transforming the portal image into the coordinate space of the DRR image using three control points placed on each image by the user, and displaying the fused image. In order to test statistically that the software actually improves setup error estimation, an intra- and interobserver phantom study was performed. Portal images of anthropomorphic thoracic and pelvis phantoms with virtually placed irradiation fields at known setup errors were prepared. A group of five doctors was first asked to estimate the setup errors by examining the portal and DRR image side-by-side, not using the software. A second group of four technicians then estimated the same set of images using the registration software. These two groups of human subjects were then compared with an auto-registration feature of the software, which is based on the mutual information between the portal and DRR images. For the thoracic case, the average distance between the actual setup error and the estimated error was 4.3 ± 3.0 mm for doctors using the side-by-side method, 2.1 ± 2.4 mm for technicians using the registration method, and 0.8 ± 0.4mm for the automatic algorithm. For the pelvis case, the average distance between the actual setup error and estimated error was 2.0 ± 0.5 mm for the doctors using the side-by-side method, 2.5 ± 0.4 mm for technicians using the registration method, and 2.0 ± 1.0 mm for the automatic algorithm. The ability of humans to estimate offset values improved statistically using our software for the chest phantom that we tested. Setup error estimation was further improved using our automatic error estimation algorithm. Estimations were not statistically different for the pelvis case. Consistency improved using the software for both the chest and pelvis phantoms. We also tested the automatic algorithm with a

  5. Patient safety and technology-driven medication - A qualitative study on how graduate nursing students navigate through complex medication administration.

    Science.gov (United States)

    Orbæk, Janne; Gaard, Mette; Fabricius, Pia; Lefevre, Rikke S; Møller, Tom

    2015-05-01

    The technology-driven medication process is complex, involving advanced technologies, patient participation and increased safety measures. Medication administration errors are frequently reported, with nurses implicated in 26-38% of in-hospital cases. This points to the need for new ways of educating nursing students in today's medication administration. To explore nursing students' experiences and competences with the technology-driven medication administration process. 16 pre-graduate nursing students were included in two focus group interviews which were recorded, transcribed and analyzed using the systematic horizontal phenomenological-hermeneutic template methodology. The interviews uncovered that understanding the technologies; professionalism and patient safety are three crucial elements in the medication process. The students expressed positivity and confidence in using technology, but were fearful of committing serious medication errors. From the nursing students' perspective, experienced nurses deviate from existing guidelines, leaving them feeling isolated in practical learning situations. Having an unclear nursing role model for the technology-driven medication process, nursing students face difficulties in identifying and adopting best practices. The impact of using technology on the frequency, type and severity of medication errors; the technologies implications on nursing professionalism and the nurses ability to secure patient adherence to the medication process, still remains to be studied. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. Errors in the administration of intravenous medications in patients undergoing anesthesia in the operating room

    Directory of Open Access Journals (Sweden)

    Juan David Miranda

    2013-03-01

    Full Text Available Errors in medication administration have affected the anesthetic practice over the time and have become a major cause of perioperative morbidity and mortality. Among different medical specialties, anesthesiology is perhaps the most likely to make mistakes in this procedure. This is because in many places around the world, a single professional "anesthesiologist" orders, prepares and administers a drug at one time and setting. For thirty years, Cooper disclosed the first reports of critical incidents and perioperative safety scheme, and in the 90s', Chopra performed a retrospective analysis, found that medication errors are the fourth most common that results in disability in 17% and death in 8%, these being preventable errors in 51% of cases. It’s essential for the safe practice of anesthesia to establish interventions for improving prevention programs, education, research and development, enabling break traditional paradigms, with the aim of making recommendations and standardize the safe administration of drugs in this field.

  7. Quality Indicators in Laboratory Medicine: the status of the progress of IFCC Working Group "Laboratory Errors and Patient Safety" project.

    Science.gov (United States)

    Sciacovelli, Laura; Lippi, Giuseppe; Sumarac, Zorica; West, Jamie; Garcia Del Pino Castro, Isabel; Furtado Vieira, Keila; Ivanov, Agnes; Plebani, Mario

    2017-03-01

    The knowledge of error rates is essential in all clinical laboratories as it enables them to accurately identify their risk level, and compare it with those of other laboratories in order to evaluate their performance in relation to the State-of-the-Art (i.e. benchmarking) and define priorities for improvement actions. Although no activity is risk free, it is widely accepted that the risk of error is minimized by the use of Quality Indicators (QIs) managed as a part of laboratory improvement strategy and proven to be suitable monitoring and improvement tools. The purpose of QIs is to keep the error risk at a level that minimizes the likelihood of patients. However, identifying a suitable State-of-the-Art is challenging, because it calls for the knowledge of error rates measured in a variety of laboratories throughout world that differ in their organization and management, context, and the population they serve. Moreover, it also depends on the choice of the events to keep under control and the individual procedure for measurement. Although many laboratory professionals believe that the systemic use of QIs in Laboratory Medicine may be effective in decreasing errors occurring throughout the total testing process (TTP), to improve patient safety as well as to satisfy the requirements of International Standard ISO 15189, they find it difficult to maintain standardized and systematic data collection, and to promote continued high level of interest, commitment and dedication in the entire staff. Although many laboratories worldwide express a willingness to participate to the Model of QIs (MQI) project of IFCC Working Group "Laboratory Errors and Patient Safety", few systematically enter/record their own results and/or use a number of QIs designed to cover all phases of the TTP. Many laboratories justify their inadequate participation in data collection of QIs by claiming that the number of QIs included in the MQI is excessive. However, an analysis of results suggests

  8. Measurement error of a simplified protocol for quantitative sensory tests in chronic pain patients

    DEFF Research Database (Denmark)

    Müller, Monika; Biurrun Manresa, José; Limacher, Andreas

    2017-01-01

    BACKGROUND AND OBJECTIVES: Large-scale application of Quantitative Sensory Tests (QST) is impaired by lacking standardized testing protocols. One unclear methodological aspect is the number of records needed to minimize measurement error. Traditionally, measurements are repeated 3 to 5 times...

  9. The application of SHERPA (Systematic Human Error Reduction and Prediction Approach) in the development of compensatory cognitive rehabilitation strategies for stroke patients with left and right brain damage.

    Science.gov (United States)

    Hughes, Charmayne M L; Baber, Chris; Bienkiewicz, Marta; Worthington, Andrew; Hazell, Alexa; Hermsdörfer, Joachim

    2015-01-01

    Approximately 33% of stroke patients have difficulty performing activities of daily living, often committing errors during the planning and execution of such activities. The objective of this study was to evaluate the ability of the human error identification (HEI) technique SHERPA (Systematic Human Error Reduction and Prediction Approach) to predict errors during the performance of daily activities in stroke patients with left and right hemisphere lesions. Using SHERPA we successfully predicted 36 of the 38 observed errors, with analysis indicating that the proportion of predicted and observed errors was similar for all sub-tasks and severity levels. HEI results were used to develop compensatory cognitive strategies that clinicians could employ to reduce or prevent errors from occurring. This study provides evidence for the reliability and validity of SHERPA in the design of cognitive rehabilitation strategies in stroke populations.

  10. Automatic detection of patient identification and positioning errors in radiation therapy treatment using 3-dimensional setup images.

    Science.gov (United States)

    Jani, Shyam S; Low, Daniel A; Lamb, James M

    2015-01-01

    To develop an automated system that detects patient identification and positioning errors between 3-dimensional computed tomography (CT) and kilovoltage CT planning images. Planning kilovoltage CT images were collected for head and neck (H&N), pelvis, and spine treatments with corresponding 3-dimensional cone beam CT and megavoltage CT setup images from TrueBeam and TomoTherapy units, respectively. Patient identification errors were simulated by registering setup and planning images from different patients. For positioning errors, setup and planning images were misaligned by 1 to 5 cm in the 6 anatomical directions for H&N and pelvis patients. Spinal misalignments were simulated by misaligning to adjacent vertebral bodies. Image pairs were assessed using commonly used image similarity metrics as well as custom-designed metrics. Linear discriminant analysis classification models were trained and tested on the imaging datasets, and misclassification error (MCE), sensitivity, and specificity parameters were estimated using 10-fold cross-validation. For patient identification, our workflow produced MCE estimates of 0.66%, 1.67%, and 0% for H&N, pelvis, and spine TomoTherapy images, respectively. Sensitivity and specificity ranged from 97.5% to 100%. MCEs of 3.5%, 2.3%, and 2.1% were obtained for TrueBeam images of the above sites, respectively, with sensitivity and specificity estimates between 95.4% and 97.7%. MCEs for 1-cm H&N/pelvis misalignments were 1.3%/5.1% and 9.1%/8.6% for TomoTherapy and TrueBeam images, respectively. Two-centimeter MCE estimates were 0.4%/1.6% and 3.1/3.2%, respectively. MCEs for vertebral body misalignments were 4.8% and 3.6% for TomoTherapy and TrueBeam images, respectively. Patient identification and gross misalignment errors can be robustly and automatically detected using 3-dimensional setup images of different energies across 3 commonly treated anatomical sites. Copyright © 2015 American Society for Radiation Oncology. Published by

  11. Non-topography-guided PRK combined with CXL for the correction of refractive errors in patients with early stage keratoconus.

    Science.gov (United States)

    Fadlallah, Ali; Dirani, Ali; Chelala, Elias; Antonios, Rafic; Cherfan, George; Jarade, Elias

    2014-10-01

    To evaluate the safety and clinical outcome of combined non-topography-guided photorefractive keratectomy (PRK) and corneal collagen cross-linking (CXL) for the treatment of mild refractive errors in patients with early stage keratoconus. A retrospective, nonrandomized study of patients with early stage keratoconus (stage 1 or 2) who underwent simultaneous non-topography-guided PRK and CXL. All patients had at least 2 years of follow-up. Data were collected preoperatively and postoperatively at the 6-month, 1-year, and 2-year follow-up visit after combined non-topography-guided PRK and CXL. Seventy-nine patients (140 eyes) were included in the study. Combined non-topography-guided PRK and CXL induced a significant improvement in both visual acuity and refraction. Uncorrected distance visual acuity significantly improved from 0.39 ± 0.22 logMAR before combined non-topography-guided PRK and CXL to 0.12 ± 0.14 logMAR at the last follow-up visit (P PRK and CXL (P PRK and CXL is an effective and safe option for correcting mild refractive error and improving visual acuity in patients with early stable keratoconus. Copyright 2014, SLACK Incorporated.

  12. The Relationships Among Perceived Patients' Safety Culture, Intention to Report Errors, and Leader Coaching Behavior of Nurses in Korea: A Pilot Study.

    Science.gov (United States)

    Ko, YuKyung; Yu, Soyoung

    2017-09-01

    This study was undertaken to explore the correlations among nurses' perceptions of patient safety culture, their intention to report errors, and leader coaching behaviors. The participants (N = 289) were nurses from 5 Korean hospitals with approximately 300 to 500 beds each. Sociodemographic variables, patient safety culture, intention to report errors, and coaching behavior were measured using self-report instruments. Data were analyzed using descriptive statistics, Pearson correlation coefficient, the t test, and the Mann-Whitney U test. Nurses' perceptions of patient safety culture and their intention to report errors showed significant differences between groups of nurses who rated their leaders as high-performing or low-performing coaches. Perceived coaching behavior showed a significant, positive correlation with patient safety culture and intention to report errors, i.e., as nurses' perceptions of coaching behaviors increased, so did their ratings of patient safety culture and error reporting. There is a need in health care settings for coaching by nurse managers to provide quality nursing care and thus improve patient safety. Programs that are systematically developed and implemented to enhance the coaching behaviors of nurse managers are crucial to the improvement of patient safety and nursing care. Moreover, a systematic analysis of the causes of malpractice, as opposed to a focus on the punitive consequences of errors, could increase error reporting and therefore promote a culture in which a higher level of patient safety can thrive.

  13. Setup accuracy of stereoscopic X-ray positioning with automated correction for rotational errors in patients treated with conformal arc radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Soete, Guy; Verellen, Dirk; Tournel, Koen; Storme, Guy

    2006-01-01

    We evaluated setup accuracy of NovalisBody stereoscopic X-ray positioning with automated correction for rotational errors with the Robotics Tilt Module in patients treated with conformal arc radiotherapy for prostate cancer. The correction of rotational errors was shown to reduce random and systematic errors in all directions. (NovalisBody TM and Robotics Tilt Module TM are products of BrainLAB A.G., Heimstetten, Germany)

  14. Evidence for Treatable Inborn Errors of Metabolism in a Cohort of 187 Greek Patients with Autism Spectrum Disorder (ASD

    Directory of Open Access Journals (Sweden)

    Martha eSpilioti

    2013-12-01

    Full Text Available We screened for the presence of inborn errors of metabolism (IEM in 187 children (105 males; 82 females, ages 4 -14 years old who presented with confirmed features of ASD. Twelve patients (7% manifested increased 3-hydroxyisovaleric acid (3-OH-IVA excretion in urine, and minor to significant improvement in autistic features was observed in seven patients following supplementation with biotin. Five diagnoses included: Lesch Nyhan syndrome (2, succinic semialdehyde dehydrogenase (SSADH deficiency (2 and phenylketonuria (1 (2.7%. Additional metabolic disturbances suggestive of IEMs included two patients whose increased urine 3-OH-IVA was accompanied by elevated methylcitrate and lactate in sera, and 30 patients that showed abnormal glucose-loading tests. In the latter group, 16/30 patients manifested increased sera beta hydroxybutyrate (b-OH-b production and 18/30 had a paradoxical increase of sera lactate. Six patients with elevated b-OH-b in sera showed improved autistic features following implementation of a ketogenic diet. Five patients showed decreased serum ketone body production with glucose loading. Twelve of 187 patients demonstrated nonspecific MRI pathology, while 25/187 had abnormal EEG findings. Finally, family history was positive for 22/187 patients (1st or 2nd degree relative with comparable symptomatology and consanguinity was documented for 12/187 patients. Our data provide evidence for a new biomarker (3-OH-IVA and novel treatment approaches in ASD patients.Concise 1 sentence take-home message: Detailed metabolic screening in a Greek cohort of autismspectrum disorder (ASD patients revealed biomarkers (urine 3-hydroxyisovaleric acid and serum b-OH-b in 7% (13/187 of patients for whom biotin supplementation or institution of a ketogenic diet resulted in mild to significant clinical improvement in autistic features.

  15. Using Healthcare Failure Mode and Effect Analysis to reduce medication errors in the process of drug prescription, validation and dispensing in hospitalised patients.

    Science.gov (United States)

    Vélez-Díaz-Pallarés, Manuel; Delgado-Silveira, Eva; Carretero-Accame, María Emilia; Bermejo-Vicedo, Teresa

    2013-01-01

    To identify actions to reduce medication errors in the process of drug prescription, validation and dispensing, and to evaluate the impact of their implementation. A Health Care Failure Mode and Effect Analysis (HFMEA) was supported by a before-and-after medication error study to measure the actual impact on error rate after the implementation of corrective actions in the process of drug prescription, validation and dispensing in wards equipped with computerised physician order entry (CPOE) and unit-dose distribution system (788 beds out of 1080) in a Spanish university hospital. The error study was carried out by two observers who reviewed medication orders on a daily basis to register prescription errors by physicians and validation errors by pharmacists. Drugs dispensed in the unit-dose trolleys were reviewed for dispensing errors. Error rates were expressed as the number of errors for each process divided by the total opportunities for error in that process times 100. A reduction in prescription errors was achieved by providing training for prescribers on CPOE, updating prescription procedures, improving clinical decision support and automating the software connection to the hospital census (relative risk reduction (RRR), 22.0%; 95% CI 12.1% to 31.8%). Validation errors were reduced after optimising time spent in educating pharmacy residents on patient safety, developing standardised validation procedures and improving aspects of the software's database (RRR, 19.4%; 95% CI 2.3% to 36.5%). Two actions reduced dispensing errors: reorganising the process of filling trolleys and drawing up a protocol for drug pharmacy checking before delivery (RRR, 38.5%; 95% CI 14.1% to 62.9%). HFMEA facilitated the identification of actions aimed at reducing medication errors in a healthcare setting, as the implementation of several of these led to a reduction in errors in the process of drug prescription, validation and dispensing.

  16. Child and family experiences with inborn errors of metabolism: a qualitative interview study with representatives of patient groups.

    Science.gov (United States)

    Khangura, Sara D; Tingley, Kylie; Chakraborty, Pranesh; Coyle, Doug; Kronick, Jonathan B; Laberge, Anne-Marie; Little, Julian; Miller, Fiona A; Mitchell, John J; Prasad, Chitra; Siddiq, Shabnaz; Siriwardena, Komudi; Sparkes, Rebecca; Speechley, Kathy N; Stockler, Sylvia; Trakadis, Yannis; Wilson, Brenda J; Wilson, Kumanan; Potter, Beth K

    2016-01-01

    Patient-centered health care for children with inborn errors of metabolism (IEM) and their families is important and requires an understanding of patient experiences, needs, and priorities. IEM-specific patient groups have emerged as important voices within these rare disease communities and are uniquely positioned to contribute to this understanding. We conducted qualitative interviews with IEM patient group representatives to increase understanding of patient and family experiences, needs, and priorities and inform patient-centered research and care. We developed a sampling frame of patient groups representing IEM disease communities from Canada, the United States, and United Kingdom. With consent, we interviewed participants to explore their views on experiences, needs, and outcomes that are most important to children with IEM and their families. We analyzed the data using a qualitative descriptive approach to identify key themes and sub-themes. We interviewed 18 organizational representatives between February 28 and September 17, 2014, representing 16 IEMs and/or disease categories. Twelve participants voluntarily self-identified as parents and/or were themselves patients. Three key themes emerged from the coded data: managing the uncertainty associated with raising and caring for a child with a rare disease; challenges associated with the affected child's life transitions, and; the collective struggle for improved outcomes and interventions that rare disease communities navigate. Health care providers can support children with IEM and their families by acknowledging and reducing uncertainty, supporting families through children's life transitions, and contributing to rare disease communities' progress toward improved interventions, experiences, and outcomes.

  17. Extent and Determinants of Error in Doctors' Prognoses in Terminally Ill Patients: Prospective Cohort Study

    OpenAIRE

    Lamont, Elizabeth; Christakis, Nicholas

    2000-01-01

    Objective: To describe doctors' prognostic accuracy in terminally ill patients and to evaluate the determinants of that accuracy. Design: Prospective cohort study. Setting: Five outpatient hospice programmes in Chicago. Participants: 343 doctors provided survival estimates for 468 terminally ill patients at the time of hospice referral. Main outcome measures: Patients' estimated and actual survival. Results: Median survival was 24 days. Only 20% (92/468) of predictions were acc...

  18. Clinical errors and medical negligence.

    Science.gov (United States)

    Oyebode, Femi

    2013-01-01

    This paper discusses the definition, nature and origins of clinical errors including their prevention. The relationship between clinical errors and medical negligence is examined as are the characteristics of litigants and events that are the source of litigation. The pattern of malpractice claims in different specialties and settings is examined. Among hospitalized patients worldwide, 3-16% suffer injury as a result of medical intervention, the most common being the adverse effects of drugs. The frequency of adverse drug effects appears superficially to be higher in intensive care units and emergency departments but once rates have been corrected for volume of patients, comorbidity of conditions and number of drugs prescribed, the difference is not significant. It is concluded that probably no more than 1 in 7 adverse events in medicine result in a malpractice claim and the factors that predict that a patient will resort to litigation include a prior poor relationship with the clinician and the feeling that the patient is not being kept informed. Methods for preventing clinical errors are still in their infancy. The most promising include new technologies such as electronic prescribing systems, diagnostic and clinical decision-making aids and error-resistant systems. Copyright © 2013 S. Karger AG, Basel.

  19. [Application of patient card technology to health care].

    Science.gov (United States)

    Sayag, E; Danon, Y L

    1995-03-15

    The potential benefits of patient card technology in improving management and delivery of health services have been explored. Patient cards can be used for numerous applications and functions: as a means of identification, as a key for an insurance payment system, and as a communication medium. Advanced card technologies allow for the storage of data on the card, creating the possibility of a comprehensive and portable patient record. There are many types of patient cards: paper or plastic cards, microfilm cards, bar-code cards, magnetic-strip cards and integrated circuit smart-cards. Choosing the right card depends on the amount of information to be stored, the degree of security required and the cost of the cards and their supporting infrastructure. Problems with patient cards are related to storage capacity, backup and data consistency, access authorization and ownership and compatibility. We think it is worth evaluating the place of patient card technology in the delivery of health services in Israel.

  20. Two sides of the safety coin?: How patient engagement and safety climate jointly affect error occurrence in hospital units.

    Science.gov (United States)

    Schiffinger, Michael; Latzke, Markus; Steyrer, Johannes

    2016-01-01

    Safety climate (SC) and more recently patient engagement (PE) have been identified as potential determinants of patient safety, but conceptual and empirical studies combining both are lacking. On the basis of extant theories and concepts in safety research, this study investigates the effect of PE in conjunction with SC on perceived error occurrence (pEO) in hospitals, controlling for various staff-, patient-, and hospital-related variables as well as the amount of stress and (lack of) organizational support experienced by staff. Besides the main effects of PE and SC on error occurrence, their interaction is examined, too. In 66 hospital units, 4,345 patients assessed the degree of PE, and 811 staff assessed SC and pEO. PE was measured with a new instrument, capturing its core elements according to a recent literature review: Information Provision (both active and passive) and Activation and Collaboration. SC and pEO were measured with validated German-language questionnaires. Besides standard regression and correlational analyses, partial least squares analysis was employed to model the main and interaction effects of PE and SC on pEO, also controlling for stress and (lack of) support perceived by staff, various staff and patient attributes, and potential single-source bias. Both PE and SC are associated with lower pEO, to a similar extent. The joint effect of these predictors suggests a substitution rather than mutually reinforcing interaction. Accounting for control variables and/or potential single-source bias slightly attenuates some effects without altering the results. Ignoring PE potentially amounts to forgoing a potential source of additional safety. On the other hand, despite the abovementioned substitution effect and conjectures of SC being inert, PE should not be considered as a replacement for SC.

  1. Application of Barcoding to Reduce Error of Patient Identification and to Increase Patient's Information Confidentiality of Test Tube Labelling in a Psychiatric Teaching Hospital.

    Science.gov (United States)

    Liu, Hsiu-Chu; Li, Hsing; Chang, Hsin-Fei; Lu, Mei-Rou; Chen, Feng-Chuan

    2015-01-01

    Learning from the experience of another medical center in Taiwan, Kaohsiung Municipal Kai-Suan Psychiatric Hospital has changed the nursing informatics system step by step in the past year and a half . We considered ethics in the original idea of implementing barcodes on the test tube labels to process the identification of the psychiatric patients. The main aims of this project are to maintain the confidential information and to transport the sample effectively. The primary nurses had been using different work sheets for this project to ensure the acceptance of the new barcode system. In the past two years the errors in the blood testing process were as high as 11,000 in 14,000 events per year, resulting in wastage of resources. The actions taken by the nurses and the new barcode system implementation can improve the clinical nursing care quality, safety of the patients, and efficiency, while decreasing the cost due to the human error.

  2. Clinical characteristics of adult patients with inborn errors of metabolism in Spain: A review of 500 cases from university hospitals

    Directory of Open Access Journals (Sweden)

    J. Pérez-López

    2017-03-01

    Full Text Available Patients with inborn errors of metabolism (IEMs have become an emerging and challenging group in the adult healthcare system whose needs should be known in order to implement appropriate policies and to adapt adult clinical departments. We aimed to analyze the clinical characteristics of adult patients with IEMs who attend the most important Spanish hospitals caring for these conditions. A cohort study was conducted in 500 patients, categorized by metabolic subtype according to pathophysiological classification. The most prevalent group of IEMs was amino acid disorders, with 108 (21.6% patients diagnosed with phenylketonuria. Lysosomal storage disorders were the second group, in which 32 (6.4% and 25 (5% patients had Fabry disease and Gaucher disease respectively. The great clinical heterogeneity, the significant delay in diagnosis after symptom onset, the existence of some degree of physical dependence in a great number of patients, the need for a multidisciplinary and coordinated approach, and the lack of specific drug treatment are common features in this group of conditions.

  3. Selective screening of 650 high risk Iranian patients for detection of inborn error of metabolism

    Directory of Open Access Journals (Sweden)

    Narges Pishva

    2015-02-01

    Full Text Available Objective: Although metabolic diseases individually are rare ,but overall have an incidence of 1/2000 and can cause devastating and irreversible effect if not diagnosed early and treated promptly. selective screening is an acceptable method for detection of these multi presentation diseases.Method: using panel neonatal screening for detection of metabolic diseases in 650 high risk Iranian patients in Fars province. The following clinical features were used as inclusion criteria for investigation of the patients.Lethargy, poor feeding ,persistent vomiting, cholestasis, intractable seizure ,decreased level of consciousness ,persistent hypoglycemia, unexplained acid base disturbance and unexplained neonatal death.Result: Organic acidemia with 40 cases (42% was the most frequent disorder diagnosed in our high risk populations, followed by disorder of galactose metabolism(30%, 15 patient had classic galactosemia(GALT

  4. Selective screening of 650 high risk Iranian patients for detection of inborn error of metabolism

    Directory of Open Access Journals (Sweden)

    Narges Pishva

    2015-02-01

    Full Text Available Objective: Although metabolic diseases individually are rare ,but overall have an incidence of 1/2000 and can cause devastating and irreversible effect if not diagnosed early and treated promptly. selective screening is an acceptable method for detection of these multi presentation diseases. Method: using panel neonatal screening for detection of metabolic diseases in 650 high risk Iranian patients in Fars province. The following clinical features were used as inclusion criteria for investigation of the patients. Lethargy, poor feeding ,persistent vomiting, cholestasis, intractable seizure ,decreased level of consciousness ,persistent hypoglycemia, unexplained acid base disturbance and unexplained neonatal death. Result: Organic acidemia with 40 cases (42% was the most frequent disorder diagnosed in our high risk populations, followed by disorder of galactose metabolism(30%, 15 patient had classic galactosemia(GALT

  5. Medication errors: prescribing faults and prescription errors.

    Science.gov (United States)

    Velo, Giampaolo P; Minuz, Pietro

    2009-06-01

    1. Medication errors are common in general practice and in hospitals. Both errors in the act of writing (prescription errors) and prescribing faults due to erroneous medical decisions can result in harm to patients. 2. Any step in the prescribing process can generate errors. Slips, lapses, or mistakes are sources of errors, as in unintended omissions in the transcription of drugs. Faults in dose selection, omitted transcription, and poor handwriting are common. 3. Inadequate knowledge or competence and incomplete information about clinical characteristics and previous treatment of individual patients can result in prescribing faults, including the use of potentially inappropriate medications. 4. An unsafe working environment, complex or undefined procedures, and inadequate communication among health-care personnel, particularly between doctors and nurses, have been identified as important underlying factors that contribute to prescription errors and prescribing faults. 5. Active interventions aimed at reducing prescription errors and prescribing faults are strongly recommended. These should be focused on the education and training of prescribers and the use of on-line aids. The complexity of the prescribing procedure should be reduced by introducing automated systems or uniform prescribing charts, in order to avoid transcription and omission errors. Feedback control systems and immediate review of prescriptions, which can be performed with the assistance of a hospital pharmacist, are also helpful. Audits should be performed periodically.

  6. Patient safety with blood products administration using wireless and bar-code technology.

    Science.gov (United States)

    Porcella, Aleta; Walker, Kristy

    2005-01-01

    Supported by a grant from the Agency for Healthcare Research and Quality, a University of Iowa Hospitals and Clinics interdisciplinary research team created an online data-capture-response tool utilizing wireless mobile devices and bar code technology to track and improve blood products administration process. The tool captures 1) sample collection, 2) sample arrival in the blood bank, 3) blood product dispense from blood bank, and 4) administration. At each step, the scanned patient wristband ID bar code is automatically compared to scanned identification barcode on requisition, sample, and/or product, and the system presents either a confirmation or an error message to the user. Following an eight-month, 5 unit, staged pilot, a 'big bang,' hospital-wide implementation occurred on February 7, 2005. Preliminary results from pilot data indicate that the new barcode process captures errors 3 to 10 times better than the old manual process.

  7. PATIENT SAFETY AND MEDICATION ERRORS IN THE PROVISION OF HEALTH CARE SERVICES-CHALLENGES FOR CONTEMPORARY PRACTICE

    Directory of Open Access Journals (Sweden)

    Tatjana Stojković

    2016-06-01

    Full Text Available Non-maleficence represents one of the basic ethical principles that health care providers should be guided by during service delivery. Establishment of patient safety is nowadays recognized as an issue of global concern in health care and a critical component of quality management. The aim of this paper is to provide a literature review of the patient safety and medication errors concept, with special attention given to defining the most significant terms, analyzing the causal factors and reviewing their classification. Raising awareness about the importance of patient safety has resulted in an increase in the number of medication error studies over the last decade. The traditional approach which makes health workers responsible for reduction of incidents is replaced by the modern concept which implies the involvement of all stakeholders at all levels of the system. In developed countries, the application of prospective risk management models for specific health care processes has already started. However, all these studies are mainly carried out at the secondary and tertiary levels of health care, while they are almost non-existent at the primary level. In the Republic of Serbia, a Rulebook on indicators of the quality of health care has been recently adopted, but a trend of significant lack of data regarding patient safety can be noticed due to inadequate reporting. It is necessary to continue with the homogenization of terminology and to increase the number of analyses of causal factors with the aim of prospective risk identification, particularly in developing countries such as the Republic of Serbia.

  8. Error Patterns

    NARCIS (Netherlands)

    Hoede, C.; Li, Z.

    2001-01-01

    In coding theory the problem of decoding focuses on error vectors. In the simplest situation code words are $(0,1)$-vectors, as are the received messages and the error vectors. Comparison of a received word with the code words yields a set of error vectors. In deciding on the original code word,

  9. European pharmacy students' experience with virtual patient technology.

    Science.gov (United States)

    Cavaco, Afonso Miguel; Madeira, Filipe

    2012-08-10

    To describe how virtual patients are being used to simulate real-life clinical scenarios in undergraduate pharmacy education in Europe. One hundred ninety-four participants at the 2011 Congress of the European Pharmaceutical Students Association (EPSA) completed an exploratory cross-sectional survey instrument. Of the 46 universities and 23 countries represented at the EPSA Congress, only 12 students from 6 universities in 6 different countries reported having experience with virtual patient technology. The students were satisfied with the virtual patient technology and considered it more useful as a teaching and learning tool than an assessment tool. Respondents who had not used virtual patient technology expressed support regarding its potential benefits in pharmacy education. French and Dutch students were significantly less interested in virtual patient technology than were their counterparts from other European countries. The limited use of virtual patients in pharmacy education in Europe suggests the need for initiatives to increase the use of virtual patient technology and the benefits of computer-assisted learning in pharmacy education.

  10. Survey of Canadian Myotonic Dystrophy Patients' Access to Computer Technology.

    Science.gov (United States)

    Climans, Seth A; Piechowicz, Christine; Koopman, Wilma J; Venance, Shannon L

    2017-09-01

    Myotonic dystrophy type 1 is an autosomal dominant condition affecting distal hand strength, energy, and cognition. Increasingly, patients and families are seeking information online. An online neuromuscular patient portal under development can help patients access resources and interact with each other regardless of location. It is unknown how individuals living with myotonic dystrophy interact with technology and whether barriers to access exist. We aimed to characterize technology use among participants with myotonic dystrophy and to determine whether there is interest in a patient portal. Surveys were mailed to 156 participants with myotonic dystrophy type 1 registered with the Canadian Neuromuscular Disease Registry. Seventy-five participants (60% female) responded; almost half were younger than 46 years. Most (84%) used the internet; almost half of the responders (47%) used social media. The complexity and cost of technology were commonly cited reasons not to use technology. The majority of responders (76%) were interested in a myotonic dystrophy patient portal. Patients in a Canada-wide registry of myotonic dystrophy have access to and use technology such as computers and mobile phones. These patients expressed interest in a portal that would provide them with an opportunity to network with others with myotonic dystrophy and to access information about the disease.

  11. Applying the Toyota Production System: using a patient safety alert system to reduce error.

    Science.gov (United States)

    Furman, Cathie; Caplan, Robert

    2007-07-01

    In 2002, Virginia Mason Medical Center (VMMC) adapted the Toyota Production System, also known as lean manufacturing. To translate the techniques of zero defects and stopping the line into health care, the Patient Safety Alert (PSA) system requires any employee who encounters a situation that is likely to harm a patient to make an immediate report and to cease any activity that could cause further harm (stopping the line). IMPLEMENTING THE PSA SYSTEM--STOPPING THE LINE: If any VMMC employee's practice or conduct is deemed capable of causing harm to a patient, a PSA can cause that person to be stopped from working until the problem is resolved. A policy statement, senior executive commitment, dedicated resources, a 24-hour hotline, and communication were all key features of implementation. As of December 2006, 6,112 PSA reports were received: 20% from managers, 8% from physicians, 44% from nurses, and 23% from nonclinical support personnel, for example. The number of reports received per month increased from an average of 3 in 2002 to 285 in 2006. Most reports were processed within 24 hours and were resolved within 2 to 3 weeks. Implementing the PSA system has drastically increased the number of safety concerns that are resolved at VMMC, while drastically reducing the time it takes to resolve them. Transparent discussion and feedback have helped promote staff acceptance and participation.

  12. [Medical errors from positions of mutual relations of patient-lawyer-doctor].

    Science.gov (United States)

    Radysh, Ia F; Tsema, Ie V; Mehed', V P

    2013-01-01

    The basic theoretical and practical aspects of problem of malpractice in the system of health protection Ukraine are presented in the article. On specific examples the essence of the term "malpractice" is expounded. It was considered types of malpractice, conditions of beginning and kinds of responsibility to assumption of malpractice. The special attention to the legal and mental and ethical questions of problem from positions of protection of rights for a patient and medical worker is spared. The necessity of qualification malpractices on intentional and unintentional, possible and impermissible is grounded.

  13. A patient with an inborn error of vitamin B12 metabolism (cblF) detected by newborn screening.

    Science.gov (United States)

    Armour, Christine M; Brebner, Alison; Watkins, David; Geraghty, Michael T; Chan, Alicia; Rosenblatt, David S

    2013-07-01

    A neonate, who was found to have an elevated C3/C2 ratio and minimally elevated propionylcarnitine on newborn screening, was subsequently identified as having the rare cblF inborn error of vitamin B12 (cobalamin) metabolism. This disorder is characterized by the retention of unmetabolized cobalamin in lysosomes such that it is not readily available for cellular metabolism. Although cultured fibroblasts from the patient did not show the expected functional abnormalities of the cobalamin-dependent enzymes, methylmalonyl-CoA mutase and methionine synthase, they did show reduced synthesis of the active cobalamin cofactors adenosylcobalamin and methylcobalamin. Mutation analysis of LMBRD1 established that the patient had the cblF disorder. Treatment was initiated promptly, and the patient showed a robust response to regular injections of cyanocobalamin, and she was later switched to hydroxocobalamin. Currently, at 3 years of age, the child is clinically well, with appropriate development. Adjusted newborn screening cutoffs in Ontario allowed detection of a deficiency that might not have otherwise been identified, allowing early treatment and perhaps preventing the adverse sequelae seen in some untreated patients.

  14. No unified reward prediction error in local field potentials from the human nucleus accumbens: evidence from epilepsy patients.

    Science.gov (United States)

    Stenner, Max-Philipp; Rutledge, Robb B; Zaehle, Tino; Schmitt, Friedhelm C; Kopitzki, Klaus; Kowski, Alexander B; Voges, Jürgen; Heinze, Hans-Jochen; Dolan, Raymond J

    2015-08-01

    Functional magnetic resonance imaging (fMRI), cyclic voltammetry, and single-unit electrophysiology studies suggest that signals measured in the nucleus accumbens (Nacc) during value-based decision making represent reward prediction errors (RPEs), the difference between actual and predicted rewards. Here, we studied the precise temporal and spectral pattern of reward-related signals in the human Nacc. We recorded local field potentials (LFPs) from the Nacc of six epilepsy patients during an economic decision-making task. On each trial, patients decided whether to accept or reject a gamble with equal probabilities of a monetary gain or loss. The behavior of four patients was consistent with choices being guided by value expectations. Expected value signals before outcome onset were observed in three of those patients, at varying latencies and with nonoverlapping spectral patterns. Signals after outcome onset were correlated with RPE regressors in all subjects. However, further analysis revealed that these signals were better explained as outcome valence rather than RPE signals, with gamble gains and losses differing in the power of beta oscillations and in evoked response amplitudes. Taken together, our results do not support the idea that postsynaptic potentials in the Nacc represent a RPE that unifies outcome magnitude and prior value expectation. We discuss the generalizability of our findings to healthy individuals and the relation of our results to measurements of RPE signals obtained from the Nacc with other methods. Copyright © 2015 the American Physiological Society.

  15. User-Centered Design and Interactive Health Technologies for Patients

    Science.gov (United States)

    De Vito Dabbs, Annette; Myers, Brad A.; Mc Curry, Kenneth R.; Dunbar-Jacob, Jacqueline; Hawkins, Robert P.; Begey, Alex; Dew, Mary Amanda

    2010-01-01

    Despite recommendations that patients be involved in the design and testing of health technologies, few reports describe how to involve patients in systematic and meaningful ways to ensure that applications are customized to meet their needs. User-centered design (UCD) is an approach that involves end-users throughout the development process so that technology support tasks, are easy to operate, and are of value to users. In this paper we provide an overview of UCD and use the development of Pocket Personal Assistant for Tracking Health (Pocket PATH), to illustrate how these principles and techniques were applied to involve patients in the development of this interactive health technology. Involving patient-users in the design and testing ensured functionality and usability, therefore increasing the likelihood of promoting the intended health outcomes. PMID:19411947

  16. Digital mobile technology facilitates HIPAA-sensitive perioperative messaging, improves physician-patient communication, and streamlines patient care.

    Science.gov (United States)

    Gordon, Chad R; Rezzadeh, Kameron S; Li, Andrew; Vardanian, Andrew; Zelken, Jonathan; Shores, Jamie T; Sacks, Justin M; Segovia, Andres L; Jarrahy, Reza

    2015-01-01

    Mobile device technology has revolutionized interpersonal communication, but the application of this technology to the physician-patient relationship remains limited due to concerns over patient confidentiality and the security of digital information. Nevertheless, there is a continued focus on improving communication between doctors and patients in all fields of medicine as a means of improving patient care. In this study, we implement a novel communications platform to demonstrate that instantaneously sharing perioperative information with surgical patients and members of their support networks can improve patient care and strengthen the physician-patient relationship. 423 consecutive patients scheduled to undergo elective surgical procedures were offered complimentary registration to a secure, web-based service designed to distribute perioperative updates to a group of recipients designated by each patient via Short Message Service (SMS) and/or email. Messages were created by attending surgeons and delivered instantaneously through the web-based platform. In the postoperative period, patients and their designated message recipients, as well as participating healthcare providers, were asked to complete a survey designed to assess their experience with the messaging system. Survey results were statistically analyzed to determine satisfaction rates. Of the qualifying 423 patients, 313 opted to enroll in the study. On average, patients selected a total of 3.5 recipients to receive perioperative updates. A total of 1,195 electronic messages were generated for distribution to designated recipients during the study period and delivered to recipients located around the world. There were no documented errors or failures in message delivery. Satisfaction surveys were completed by 190 users of the service (73 %). Respondents identified themselves as either patients (n = 48, 25.5 %), family/friends (n = 120, 63.8 %), or healthcare providers (n = 15, 12

  17. Doctor-Patient Knowledge Transfer: Innovative Technologies and Policy Implications

    OpenAIRE

    Sára, Zoltán; Csedő, Zoltán; Tóth, Tamás; Fejes, József; Pörzse, Gábor

    2013-01-01

    The aim of this study was to empirically investigate the barriers in doctor-patient communication and knowledge transfer and the role of innovative technologies in overcoming these barriers. We applied qualitative research methods. Our results show that patients extensively use information sources, primarily the Internet before the visits. Patients regularly apply a self-diagnosis regarding their diseases. This implies several risks as many of them are not able to properly inte...

  18. Errors in Neonatology

    OpenAIRE

    Antonio Boldrini; Rosa T. Scaramuzzo; Armando Cuttano

    2013-01-01

    Introduction: Danger and errors are inherent in human activities. In medical practice errors can lean to adverse events for patients. Mass media echo the whole scenario. Methods: We reviewed recent published papers in PubMed database to focus on the evidence and management of errors in medical practice in general and in Neonatology in particular. We compared the results of the literature with our specific experience in Nina Simulation Centre (Pisa, Italy). Results: In Neonatology the main err...

  19. Patient safety incident reports related to traditional Japanese Kampo medicines: medication errors and adverse drug events in a university hospital for a ten-year period.

    Science.gov (United States)

    Shimada, Yutaka; Fujimoto, Makoto; Nogami, Tatsuya; Watari, Hidetoshi; Kitahara, Hideyuki; Misawa, Hiroki; Kimbara, Yoshiyuki

    2017-12-21

    Kampo medicine is traditional Japanese medicine, which originated in ancient traditional Chinese medicine, but was introduced and developed uniquely in Japan. Today, Kampo medicines are integrated into the Japanese national health care system. Incident reporting systems are currently being widely used to collect information about patient safety incidents that occur in hospitals. However, no investigations have been conducted regarding patient safety incident reports related to Kampo medicines. The aim of this study was to survey and analyse incident reports related to Kampo medicines in a Japanese university hospital to improve future patient safety. We selected incident reports related to Kampo medicines filed in Toyama University Hospital from May 2007 to April 2017, and investigated them in terms of medication errors and adverse drug events. Out of 21,324 total incident reports filed in the 10-year survey period, we discovered 108 Kampo medicine-related incident reports. However, five cases were redundantly reported; thus, the number of actual incidents was 103. Of those, 99 incidents were classified as medication errors (77 administration errors, 15 dispensing errors, and 7 prescribing errors), and four were adverse drug events, namely Kampo medicine-induced interstitial pneumonia. The Kampo medicine (crude drug) that was thought to induce interstitial pneumonia in all four cases was Scutellariae Radix, which is consistent with past reports. According to the incident severity classification system recommended by the National University Hospital Council of Japan, of the 99 medication errors, 10 incidents were classified as level 0 (an error occurred, but the patient was not affected) and 89 incidents were level 1 (an error occurred that affected the patient, but did not cause harm). Of the four adverse drug events, two incidents were classified as level 2 (patient was transiently harmed, but required no treatment), and two incidents were level 3b (patient was

  20. Technologies of Compliance? : Telecare technologies and self-management of COPD patients

    NARCIS (Netherlands)

    Maathuis, Ivo; Oudshoorn, Nelly E.J.

    2016-01-01

    In current healthcare discourses self-management has been articulated as one of the major aims of telecare technologies for chronic patients. This article investigates what forms of self-management are inscribed during the design of a telecare system for patients with COPD (Chronic Obstructive

  1. The effectiveness of inking needle core prostate biopsies for preventing patient specimen identification errors: a technique to address Joint Commission patient safety goals in specialty laboratories.

    Science.gov (United States)

    Raff, Lester J; Engel, George; Beck, Kenneth R; O'Brien, Andrea S; Bauer, Meagan E

    2009-02-01

    The elimination or reduction of medical errors has been a main focus of health care enterprises in the United States since the year 2000. Elimination of errors in patient and specimen identification is a key component of this focus and is the number one goal in the Joint Commission's 2008 National Patient Safety Goals Laboratory Services Program. To evaluate the effectiveness of using permanent inks to maintain specimen identity in sequentially submitted prostate needle biopsies. For a 12-month period, a grossing technician stained each prostate core with permanent ink developed for inking of pathology specimens. A different color was used for each patient, with all the prostate cores from all vials for a particular patient inked with the same color. Five colors were used sequentially: green, blue, yellow, orange, and black. The ink was diluted with distilled water to a consistency that allowed application of a thin, uniform coating of ink along the edges of the prostate core. The time required to ink patient specimens comprising different numbers of vials and prostate biopsies was timed. The number and type of inked specimen discrepancies were evaluated. The identified discrepancy rate for prostate biopsy patients was 0.13%. The discrepancy rate in terms of total number of prostate blocks was 0.014%. Diluted inks adhered to biopsy contours throughout tissue processing. The tissue showed no untoward reactions to the inks. Inking did not affect staining (histochemical or immunohistochemical) or pathologic evaluation. On average, inking prostate needle biopsies increases grossing time by 20%. Inking of all prostate core biopsies with colored inks, in sequential order, is an aid in maintaining specimen identity. It is a simple and effective method of addressing Joint Commission patient safety goals by maintaining specimen identity during processing of similar types of gross specimens. This technique may be applicable in other specialty laboratories and high

  2. Operator errors

    International Nuclear Information System (INIS)

    Knuefer; Lindauer

    1980-01-01

    Besides that at spectacular events a combination of component failure and human error is often found. Especially the Rasmussen-Report and the German Risk Assessment Study show for pressurised water reactors that human error must not be underestimated. Although operator errors as a form of human error can never be eliminated entirely, they can be minimized and their effects kept within acceptable limits if a thorough training of personnel is combined with an adequate design of the plant against accidents. Contrary to the investigation of engineering errors, the investigation of human errors has so far been carried out with relatively small budgets. Intensified investigations in this field appear to be a worthwhile effort. (orig.)

  3. Set-up errors in patients undergoing image guided radiation treatment. Relationship to body mass index and weight loss

    DEFF Research Database (Denmark)

    Johansen, Jørgen; Bertelsen, Anders; Hansen, Christian Rønn

    2008-01-01

    by the relative weight change over time. Results: The SD of the translational and rotational random set-up errors during the first three sessions for H&N were 0.9 mm (Left-Right), 1.1mm (Anterior-Posterior), 0.7 mm (Cranio-Caudal) and 0.7 degrees (LR-axis), 0.5 degrees (AP-axis), and 0.7 degrees (CC......-axis). The equivalent data for lung cancer patients were 1.1 mm (LR), 1.1mm (AP), 1.5 mm (CC) and 0.5 degrees (LR-axis), 0.6 degrees (AP-axis), and 0.4 degrees (CC-axis). The median BMI for H&N and lung was 25.8 (17.6-39.7) and 23.7 (17.4-38.8), respectively. The median weekly weight change for H&N was -0.3% (-2.0 to 1...... (H&N) and 20 lung cancer patients were investigated. Patients were positioned using customized immobilization devices consisting of vacuum cushions and thermoplastic shells. Treatment was given on an Elekta Synergy accelerator. Cone-beam acquisitions were obtained according to a standardized Action...

  4. SU-F-I-03: Correction of Intra-Fractional Set-Up Errors and Target Coverage Based On Cone-Beam Computed Tomography for Cervical Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, JY [Cancer Hospital of Shantou University Medical College, Shantou, Guangdong (China); Hong, DL [The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong (China)

    2016-06-15

    Purpose: The purpose of this study is to investigate the patient set-up error and interfraction target coverage in cervical cancer using image-guided adaptive radiotherapy (IGART) with cone-beam computed tomography (CBCT). Methods: Twenty cervical cancer patients undergoing intensity modulated radiotherapy (IMRT) were randomly selected. All patients were matched to the isocenter using laser with the skin markers. Three dimensional CBCT projections were acquired by the Varian Truebeam treatment system. Set-up errors were evaluated by radiation oncologists, after CBCT correction. The clinical target volume (CTV) was delineated on each CBCT, and the planning target volume (PTV) coverage of each CBCT-CTVs was analyzed. Results: A total of 152 CBCT scans were acquired from twenty cervical cancer patients, the mean set-up errors in the longitudinal, vertical, and lateral direction were 3.57, 2.74 and 2.5mm respectively, without CBCT corrections. After corrections, these were decreased to 1.83, 1.44 and 0.97mm. For the target coverage, CBCT-CTV coverage without CBCT correction was 94% (143/152), and 98% (149/152) with correction. Conclusion: Use of CBCT verfication to measure patient setup errors could be applied to improve the treatment accuracy. In addition, the set-up error corrections significantly improve the CTV coverage for cervical cancer patients.

  5. Portable bathtub: technology for bed bath in bedridden patients

    Directory of Open Access Journals (Sweden)

    Dirce Stein Backes

    Full Text Available ABSTRACT Objective: determine the benefits of the Portable Bathtub as technology for bed bath in bedridden patients. Method: qualitative research of exploratory-descriptive character, whose data were collected by means of 30 interviews with patients, family members and professionals directly involved in bed bath, carried out with Portable Bathtub, in bedridden patients of a medical clinic, from July to December 2015. Results: from the data encoded by thematic content analysis resulted two categories: Portable Bathtub: from morphine to the patient's rekindled eyes; From mechanized practice to unique, transforming care. Conclusion: we concluded that the Portable Bathtub constitutes enhancing technology, as it enables clinical improvement of the patient's general condition and transcends traditional mechanized practices by the reach of advanced nursing care practices.

  6. Portable bathtub: technology for bed bath in bedridden patients.

    Science.gov (United States)

    Backes, Dirce Stein; Gomes, Carine Alves; Pereira, Simone Barbosa; Teles, Noelucy Ferreira; Backes, Marli Terezinha Stein

    2017-04-01

    determine the benefits of the Portable Bathtub as technology for bed bath in bedridden patients. qualitative research of exploratory-descriptive character, whose data were collected by means of 30 interviews with patients, family members and professionals directly involved in bed bath, carried out with Portable Bathtub, in bedridden patients of a medical clinic, from July to December 2015. from the data encoded by thematic content analysis resulted two categories: Portable Bathtub: from morphine to the patient's rekindled eyes; From mechanized practice to unique, transforming care. we concluded that the Portable Bathtub constitutes enhancing technology, as it enables clinical improvement of the patient's general condition and transcends traditional mechanized practices by the reach of advanced nursing care practices.

  7. Empowering Patients through Healthcare Technology and Information? The Challenge of becoming a Patient 2.0

    DEFF Research Database (Denmark)

    Brodersen, Søsser Grith Kragh; Lindegaard, Hanne

    2015-01-01

    of themselves appeared in newspapers, and self-management and telecare technologies were seen as ways to change elderly patients practices. Transformation of the traditional healthcare system remains on the agenda, and it continues to challenge the traditional view of the patient role (framed in this article...... on numerical representations of illness (i.e., metrics) than on direct observations of patients. Through ethnographic research in the Danish healthcare sector, we show how this new healthcare vision actually manifests in practice by presenting cases of elderly heart and diabetes patients. Technologies aimed......Abstract: In the mid-2000s, the term Patient 2.0 began to be used to denote a new patient role: empowered patients were expected to engage with various types of information and specific technologies in order to manage their own illnesses. Headlines such as Future patients will take care...

  8. Characteristics of patients making serious inhaler errors with a dry powder inhaler and association with asthma-related events in a primary care setting

    Science.gov (United States)

    Westerik, Janine A. M.; Carter, Victoria; Chrystyn, Henry; Burden, Anne; Thompson, Samantha L.; Ryan, Dermot; Gruffydd-Jones, Kevin; Haughney, John; Roche, Nicolas; Lavorini, Federico; Papi, Alberto; Infantino, Antonio; Roman-Rodriguez, Miguel; Bosnic-Anticevich, Sinthia; Lisspers, Karin; Ställberg, Björn; Henrichsen, Svein Høegh; van der Molen, Thys; Hutton, Catherine; Price, David B.

    2016-01-01

    Abstract Objective: Correct inhaler technique is central to effective delivery of asthma therapy. The study aim was to identify factors associated with serious inhaler technique errors and their prevalence among primary care patients with asthma using the Diskus dry powder inhaler (DPI). Methods: This was a historical, multinational, cross-sectional study (2011–2013) using the iHARP database, an international initiative that includes patient- and healthcare provider-reported questionnaires from eight countries. Patients with asthma were observed for serious inhaler errors by trained healthcare providers as predefined by the iHARP steering committee. Multivariable logistic regression, stepwise reduced, was used to identify clinical characteristics and asthma-related outcomes associated with ≥1 serious errors. Results: Of 3681 patients with asthma, 623 (17%) were using a Diskus (mean [SD] age, 51 [14]; 61% women). A total of 341 (55%) patients made ≥1 serious errors. The most common errors were the failure to exhale before inhalation, insufficient breath-hold at the end of inhalation, and inhalation that was not forceful from the start. Factors significantly associated with ≥1 serious errors included asthma-related hospitalization the previous year (odds ratio [OR] 2.07; 95% confidence interval [CI], 1.26–3.40); obesity (OR 1.75; 1.17–2.63); poor asthma control the previous 4 weeks (OR 1.57; 1.04–2.36); female sex (OR 1.51; 1.08–2.10); and no inhaler technique review during the previous year (OR 1.45; 1.04–2.02). Conclusions: Patients with evidence of poor asthma control should be targeted for a review of their inhaler technique even when using a device thought to have a low error rate. PMID:26810934

  9. Increased Patient Satisfaction and a Reduction in Pre-Analytical Errors Following Implementation of an Electronic Specimen Collection Module in Outpatient Phlebotomy.

    Science.gov (United States)

    Kantartjis, Michalis; Melanson, Stacy E F; Petrides, Athena K; Landman, Adam B; Bates, David W; Rosner, Bernard A; Goonan, Ellen; Bixho, Ida; Tanasijevic, Milenko J

    2017-08-01

    Patient satisfaction in outpatient phlebotomy settings typically depends on wait time and venipuncture experience, and many patients equate their experiences with their overall satisfaction with the hospital. We compared patient service times and preanalytical errors pre- and postimplementation of an integrated electronic health record (EHR)-laboratory information system (LIS) and electronic specimen collection module. We also measured patient wait time and assessed patient satisfaction using a 5-question survey. The percentage of patients waiting less than 10 minutes increased from 86% preimplementation to 93% postimplementation of the EHR-LIS (P ≤.001). The median total service time decreased significantly, from 6 minutes (IQR, 4-8 minutes), to 5 minutes (IQR, 3-6 minutes) (P = .005). The preanalytical errors decreased significantly, from 3.20 to 1.93 errors per 1000 specimens (P ≤.001). Overall patient satisfaction improved, with an increase in excellent responses for all 5 questions (P ≤.001). We found several benefits of implementing an electronic specimen collection module, including decreased wait and service times, improved patient satisfaction, and a reduction in preanalytical errors. © American Society for Clinical Pathology, 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  10. Cloud computing and patient engagement: leveraging available technology.

    Science.gov (United States)

    Noblin, Alice; Cortelyou-Ward, Kendall; Servan, Rosa M

    2014-01-01

    Cloud computing technology has the potential to transform medical practices and improve patient engagement and quality of care. However, issues such as privacy and security and "fit" can make incorporation of the cloud an intimidating decision for many physicians. This article summarizes the four most common types of clouds and discusses their ideal uses, how they engage patients, and how they improve the quality of care offered. This technology also can be used to meet Meaningful Use requirements 1 and 2; and, if speculation is correct, the cloud will provide the necessary support needed for Meaningful Use 3 as well.

  11. Intrafractional setup errors in patients undergoing non-invasive fixation using an immobilization system during hypofractionated stereotactic radiotherapy for lung tumors

    International Nuclear Information System (INIS)

    Watanabe, Meguru; Onishi, Hiroshi; Kuriyama, Kengo

    2013-01-01

    Intrafractional setup errors during hypofractionated stereotactic radiotherapy (SRT) were investigated on the patient under voluntary breath-holding conditions with non-invasive immobilization on the CT-linac treatment table. A total of 30 patients with primary and metastatic lung tumors were treated with the hypofractionated SRT with a total dose of 48-60 Gy with four treatment fractions. The patient was placed supine and stabilized on the table with non-invasive patient fixation. Intrafractional setup errors in Right/Left (R.L.), Posterior/Anterior (P.A.), and Inferior/Superior (I.S.) dimensions were analyzed with pre- and post-irradiation CT images. The means and one standard deviation of the intrafractional errors were 0.9±0.7 mm (R.L.), 0.9±0.7 mm (P.A.) and 0.5±1.0 mm (I.S.). Setup errors in each session of the treatment demonstrated no statistically significant difference in the mean value between any two sessions. The frequency within 3 mm displacement was 98% in R.L., 98% in P.A. and 97% in I.S. directions. SRT under the non-invasive patient fixation immobilization system with a comparatively loose vacuum pillow demonstrated satisfactory reproducibility of minimal setup errors with voluntary breath-holding conditions that required a small internal margin. (author)

  12. Leveraging Interactive Patient Care Technology to Improve Pain Management Engagement.

    Science.gov (United States)

    Rao-Gupta, Suma; Kruger, David; Leak, Lonna D; Tieman, Lisa A; Manworren, Renee C B

    2017-12-15

    Most children experience pain in hospitals; and their parents report dissatisfaction with how well pain was managed. Engaging patients and families in the development and evaluation of pain treatment plans may improve perceptions of pain management and hospital experiences. The aim of this performance improvement project was to engage patients and families to address hospitalized pediatric patients' pain using interactive patient care technology. The goal was to stimulate conversations about pain management expectations and perceptions of treatment plan effectiveness among patients, parents, and health care teams. Plan-Do-Study-Act was used to design, develop, test, and pilot new workflows to integrate the interactive patient care technology system with the automated medication dispensing system and document actions from both systems into the electronic health record. The pediatric surgical unit and hematology/oncology unit of a free-standing, university-affiliated, urban children's hospital were selected to pilot this performance improvement project because of the high prevalence of pain from surgeries and hematologic and oncologic diseases, treatments, and invasive procedures. Documentation of pain assessments, nonpharmacologic interventions, and evaluation of treatment effectiveness increased. The proportion of positive family satisfaction responses for pain management significantly increased from fiscal year 2014 to fiscal year 2016 (p = .006). By leveraging interactive patient care technologies, patients and families were engaged to take an active role in pain treatment plans and evaluation of treatment outcomes. Improved active communication and partnership with patients and families can effectively change organizational culture to be more sensitive to patients' pain and patients' and families' hospital experiences. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  13. Paediatric Patient Safety and the Need for Aviation Black Box Thinking to Learn From and Prevent Medication Errors.

    Science.gov (United States)

    Huynh, Chi; Wong, Ian C K; Correa-West, Jo; Terry, David; McCarthy, Suzanne

    2017-04-01

    Since the publication of To Err Is Human: Building a Safer Health System in 1999, there has been much research conducted into the epidemiology, nature and causes of medication errors in children, from prescribing and supply to administration. It is reassuring to see growing evidence of improving medication safety in children; however, based on media reports, it can be seen that serious and fatal medication errors still occur. This critical opinion article examines the problem of medication errors in children and provides recommendations for research, training of healthcare professionals and a culture shift towards dealing with medication errors. There are three factors that we need to consider to unravel what is missing and why fatal medication errors still occur. (1) Who is involved and affected by the medication error? (2) What factors hinder staff and organisations from learning from mistakes? Does the fear of litigation and criminal charges deter healthcare professionals from voluntarily reporting medication errors? (3) What are the educational needs required to prevent medication errors? It is important to educate future healthcare professionals about medication errors and human factors to prevent these from happening. Further research is required to apply aviation's 'black box' principles in healthcare to record and learn from near misses and errors to prevent future events. There is an urgent need for the black box investigations to be published and made public for the benefit of other organisations that may have similar potential risks for adverse events. International sharing of investigations and learning is also needed.

  14. Residual setup errors caused by rotation and non-rigid motion in prone-treated cervical cancer patients after online CBCT image-guidance

    International Nuclear Information System (INIS)

    Ahmad, Rozilawati; Hoogeman, Mischa S.; Quint, Sandra; Mens, Jan Willem; Osorio, Eliana M. Vásquez; Heijmen, Ben J.M.

    2012-01-01

    Purpose: To quantify the impact of uncorrected or partially corrected pelvis rotation and spine bending on region-specific residual setup errors in prone-treated cervical cancer patients. Methods and materials: Fifteen patients received an in-room CBCT scan twice a week. CBCT scans were registered to the planning CT-scan using a pelvic clip box and considering both translations and rotations. For daily correction of the detected translational pelvis setup errors by couch shifts, residual setup errors were determined for L5, L4 and seven other points of interest (POIs). The same was done for a procedure with translational corrections and limited rotational correction (±3°) by a 6D positioning device. Results: With translational correction only, residual setup errors were large especially for L5/L4 in AP direction (Σ = 5.1/5.5 mm). For the 7 POIs the residual setup errors ranged from 1.8 to 5.6 mm (AP). Using the 6D positioning device, the errors were substantially smaller (for L5/L4 in AP direction Σ = 2.7/2.2 mm). Using this device, the percentage of fractions with a residual AP displacement for L4 > 5 mm reduced from 47% to 9%. Conclusions: Setup variations caused by pelvis rotations are large and cannot be ignored in prone treatment of cervical cancer patients. Corrections with a 6D positioning device may considerably reduce resulting setup errors, but the residual setup errors should still be accounted for by appropriate CTV-to-PTV margins.

  15. Practice improvement, part II: update on patient communication technologies.

    Science.gov (United States)

    Roett, Michelle A; Coleman, Mary Thoesen

    2013-11-01

    Patient portals (ie, secure web-based services for patient health record access) and secure messaging to health care professionals are gaining popularity slowly. Advantages of web portals include timely communication and instruction, access to appointments and other services, and high patient satisfaction. Limitations include inappropriate use, security considerations, organizational costs, and exclusion of patients who are uncomfortable with or unable to use computers. Attention to the organization's strategic plan and office policies, patient and staff expectations, workflow and communication integration, training, marketing, and enrollment can facilitate optimal use of this technology. Other communication technologies that can enhance patient care include automated voice or text reminders and brief electronic communications. Social media provide another method of patient outreach, but privacy and access are concerns. Incorporating telehealthcare (health care provided via telephone or Internet), providing health coaching, and using interactive health communication applications can improve patient knowledge and clinical outcomes and provide social support. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  16. The therapeutic rehabilitation for paraplegic patients: Impact from the technologies

    Directory of Open Access Journals (Sweden)

    Ángelo Hidalgo Martínez

    2017-04-01

    Full Text Available The present article deals with the particularities of the treatment of medullar injuries as an antecedent of physical rehabilitation via health technologies. The organization of therapeutic activities and actions via these technologies, methods and techniques allows the treatment of paraplegic patients. In this research it is elaborated a programme of physical therapeutic exercises for the rehabilitation of paraplegic patients from the clinic Los Coihuesin Santiago de Chile, improving the health situation of the medullar injuries and other similar diseases. It si also included some exercises that the author considers very beneficial for rehabilitation and can be adjusted to each and every stages proposed in this research. For the development of this study it is carried out some methods such as observation, documentary revision about the technologies and techniques existing in different programmes of rehabilitation.

  17. Collaborative Affordances of Hybrid Patient Record Technologies in Medical Work

    DEFF Research Database (Denmark)

    Houben, Steven; Frost, Mads; Bardram, Jakob E

    2015-01-01

    explored the integration of paper and digital technology, there are still a wide range of open issues in the design of technologies that integrate digital and paper-based medical records. This paper studies the use of one such novel technology, called the Hybrid Patient Record (HyPR), that is designed......The medical record is a central artifact used to organize, communicate and coordinate information related to patient care. Despite recent deployments of electronic health records (EHR), paper medical records are still widely used because of the affordances of paper. Although a number of approaches...... to digitally augment a paper medical record. We report on two studies: a field study in which we describe the benefits and challenges of using a combination of electronic and paper-based medical records in a large university hospital and a deployment study in which we analyze how 8 clinicians used the Hy...

  18. Effect of Body Mass Index on Magnitude of Setup Errors in Patients Treated With Adjuvant Radiotherapy for Endometrial Cancer With Daily Image Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Lilie L., E-mail: lin@uphs.upenn.edu [Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA (United States); Hertan, Lauren; Rengan, Ramesh; Teo, Boon-Keng Kevin [Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA (United States)

    2012-06-01

    Purpose: To determine the impact of body mass index (BMI) on daily setup variations and frequency of imaging necessary for patients with endometrial cancer treated with adjuvant intensity-modulated radiotherapy (IMRT) with daily image guidance. Methods and Materials: The daily shifts from a total of 782 orthogonal kilovoltage images from 30 patients who received pelvic IMRT between July 2008 and August 2010 were analyzed. The BMI, mean daily shifts, and random and systematic errors in each translational and rotational direction were calculated for each patient. Margin recipes were generated based on BMI. Linear regression and spearman rank correlation analysis were performed. To simulate a less-than-daily IGRT protocol, the average shift of the first five fractions was applied to subsequent setups without IGRT for assessing the impact on setup error and margin requirements. Results: Median BMI was 32.9 (range, 23-62). Of the 30 patients, 16.7% (n = 5) were normal weight (BMI <25); 23.3% (n = 7) were overweight (BMI {>=}25 to <30); 26.7% (n = 8) were mildly obese (BMI {>=}30 to <35); and 33.3% (n = 10) were moderately to severely obese (BMI {>=} 35). On linear regression, mean absolute vertical, longitudinal, and lateral shifts positively correlated with BMI (p = 0.0127, p = 0.0037, and p < 0.0001, respectively). Systematic errors in the longitudinal and vertical direction were found to be positively correlated with BMI category (p < 0.0001 for both). IGRT for the first five fractions, followed by correction of the mean error for all subsequent fractions, led to a substantial reduction in setup error and resultant margin requirement overall compared with no IGRT. Conclusions: Daily shifts, systematic errors, and margin requirements were greatest in obese patients. For women who are normal or overweight, a planning target margin margin of 7 to 10 mm may be sufficient without IGRT, but for patients who are moderately or severely obese, this is insufficient.

  19. Effect of Body Mass Index on Magnitude of Setup Errors in Patients Treated With Adjuvant Radiotherapy for Endometrial Cancer With Daily Image Guidance

    International Nuclear Information System (INIS)

    Lin, Lilie L.; Hertan, Lauren; Rengan, Ramesh; Teo, Boon-Keng Kevin

    2012-01-01

    Purpose: To determine the impact of body mass index (BMI) on daily setup variations and frequency of imaging necessary for patients with endometrial cancer treated with adjuvant intensity-modulated radiotherapy (IMRT) with daily image guidance. Methods and Materials: The daily shifts from a total of 782 orthogonal kilovoltage images from 30 patients who received pelvic IMRT between July 2008 and August 2010 were analyzed. The BMI, mean daily shifts, and random and systematic errors in each translational and rotational direction were calculated for each patient. Margin recipes were generated based on BMI. Linear regression and spearman rank correlation analysis were performed. To simulate a less-than-daily IGRT protocol, the average shift of the first five fractions was applied to subsequent setups without IGRT for assessing the impact on setup error and margin requirements. Results: Median BMI was 32.9 (range, 23–62). Of the 30 patients, 16.7% (n = 5) were normal weight (BMI <25); 23.3% (n = 7) were overweight (BMI ≥25 to <30); 26.7% (n = 8) were mildly obese (BMI ≥30 to <35); and 33.3% (n = 10) were moderately to severely obese (BMI ≥ 35). On linear regression, mean absolute vertical, longitudinal, and lateral shifts positively correlated with BMI (p = 0.0127, p = 0.0037, and p < 0.0001, respectively). Systematic errors in the longitudinal and vertical direction were found to be positively correlated with BMI category (p < 0.0001 for both). IGRT for the first five fractions, followed by correction of the mean error for all subsequent fractions, led to a substantial reduction in setup error and resultant margin requirement overall compared with no IGRT. Conclusions: Daily shifts, systematic errors, and margin requirements were greatest in obese patients. For women who are normal or overweight, a planning target margin margin of 7 to 10 mm may be sufficient without IGRT, but for patients who are moderately or severely obese, this is insufficient.

  20. Development of sterilized porridge for patients by combined treatment of food technology with radiation technology

    International Nuclear Information System (INIS)

    Kim, Jaehun; Choi, Jongil; Song, Beomseok

    2010-09-01

    This research was conducted to develop patient foods of high quality using a radiation fusion technology with food processing. Radiation technique to increase calorie of porridge was established, and it was investigated that radiation effects on functional materials, which can could be added to increase functionality of patient foods. Moreover, sterilized semi-fluid meal (milk porridge) for patients with higher calorie was developed by a sterilization process by gamma irradiation, combined treatments to improve the sensory qualities, and fortification with various nutrients. Also, sensory survey on irradiated commercial patient foods was performed to find the problems and improvement points of the developed products. Optimal packaging material was selected by evaluation of effect of irradiation in packaging materials and a convenient package for consuming by patients was decided. Safety of the irradiated milk porridge was confirmed by in-vivo genotoxicological test, and its nutritional composition for patients was evaluated by nutritional analysis. Finally, the milk porridge was developed as liquid, dried, powdered, and pellet type products. This research may contribute to improve life quality of patients by supplement of various foods with high quality to immuno-compromised patients. Furthermore, economic profits and technological advances are expected by commercialization of the patient foods

  1. Development of sterilized porridge for patients by combined treatment of food technology with radiation technology

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jaehun; Choi, Jongil; Song, Beomseok; and others

    2010-09-15

    This research was conducted to develop patient foods of high quality using a radiation fusion technology with food processing. Radiation technique to increase calorie of porridge was established, and it was investigated that radiation effects on functional materials, which can could be added to increase functionality of patient foods. Moreover, sterilized semi-fluid meal (milk porridge) for patients with higher calorie was developed by a sterilization process by gamma irradiation, combined treatments to improve the sensory qualities, and fortification with various nutrients. Also, sensory survey on irradiated commercial patient foods was performed to find the problems and improvement points of the developed products. Optimal packaging material was selected by evaluation of effect of irradiation in packaging materials and a convenient package for consuming by patients was decided. Safety of the irradiated milk porridge was confirmed by in-vivo genotoxicological test, and its nutritional composition for patients was evaluated by nutritional analysis. Finally, the milk porridge was developed as liquid, dried, powdered, and pellet type products. This research may contribute to improve life quality of patients by supplement of various foods with high quality to immuno-compromised patients. Furthermore, economic profits and technological advances are expected by commercialization of the patient foods.

  2. Reliability and measurement error of sagittal spinal motion parameters in 220 patients with chronic low back pain using a three-dimensional measurement device.

    Science.gov (United States)

    Mieritz, Rune M; Bronfort, Gert; Jakobsen, Markus D; Aagaard, Per; Hartvigsen, Jan

    2014-09-01

    A basic premise for any instrument measuring spinal motion is that reliable outcomes can be obtained on a relevant sample under standardized conditions. The purpose of this study was to assess the overall reliability and measurement error of regional spinal sagittal plane motion in patients with chronic low back pain (LBP), and then to evaluate the influence of body mass index, examiner, gender, stability of pain, and pain distribution on reliability and measurement error. This study comprises a test-retest design separated by 7 to 14 days. The patient cohort consisted of 220 individuals with chronic LBP. Kinematics of the lumbar spine were sampled during standardized spinal extension-flexion testing using a 6-df instrumented spatial linkage system. Test-retest reliability and measurement error were evaluated using interclass correlation coefficients (ICC(1,1)) and Bland-Altman limits of agreement (LOAs). The overall test-retest reliability (ICC(1,1)) for various motion parameters ranged from 0.51 to 0.70, and relatively wide LOAs were observed for all parameters. Reliability measures in patient subgroups (ICC(1,1)) ranged between 0.34 and 0.77. In general, greater (ICC(1,1)) coefficients and smaller LOAs were found in subgroups with patients examined by the same examiner, patients with a stable pain level, patients with a body mass index less than below 30 kg/m(2), patients who were men, and patients in the Quebec Task Force classifications Group 1. This study shows that sagittal plane kinematic data from patients with chronic LBP may be sufficiently reliable in measurements of groups of patients. However, because of the large LOAs, this test procedure appears unusable at the individual patient level. Furthermore, reliability and measurement error varies substantially among subgroups of patients. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Analysis of Medication Error Reports

    Energy Technology Data Exchange (ETDEWEB)

    Whitney, Paul D.; Young, Jonathan; Santell, John; Hicks, Rodney; Posse, Christian; Fecht, Barbara A.

    2004-11-15

    In medicine, as in many areas of research, technological innovation and the shift from paper based information to electronic records has created a climate of ever increasing availability of raw data. There has been, however, a corresponding lag in our abilities to analyze this overwhelming mass of data, and classic forms of statistical analysis may not allow researchers to interact with data in the most productive way. This is true in the emerging area of patient safety improvement. Traditionally, a majority of the analysis of error and incident reports has been carried out based on an approach of data comparison, and starts with a specific question which needs to be answered. Newer data analysis tools have been developed which allow the researcher to not only ask specific questions but also to “mine” data: approach an area of interest without preconceived questions, and explore the information dynamically, allowing questions to be formulated based on patterns brought up by the data itself. Since 1991, United States Pharmacopeia (USP) has been collecting data on medication errors through voluntary reporting programs. USP’s MEDMARXsm reporting program is the largest national medication error database and currently contains well over 600,000 records. Traditionally, USP has conducted an annual quantitative analysis of data derived from “pick-lists” (i.e., items selected from a list of items) without an in-depth analysis of free-text fields. In this paper, the application of text analysis and data analysis tools used by Battelle to analyze the medication error reports already analyzed in the traditional way by USP is described. New insights and findings were revealed including the value of language normalization and the distribution of error incidents by day of the week. The motivation for this effort is to gain additional insight into the nature of medication errors to support improvements in medication safety.

  4. Einstein's error

    International Nuclear Information System (INIS)

    Winterflood, A.H.

    1980-01-01

    In discussing Einstein's Special Relativity theory it is claimed that it violates the principle of relativity itself and that an anomalous sign in the mathematics is found in the factor which transforms one inertial observer's measurements into those of another inertial observer. The apparent source of this error is discussed. Having corrected the error a new theory, called Observational Kinematics, is introduced to replace Einstein's Special Relativity. (U.K.)

  5. Validating Domains of Patient Contextual Factors Essential to Preventing Contextual Errors: A Qualitative Study Conducted at Chicago Area Veterans Health Administration Sites.

    Science.gov (United States)

    Binns-Calvey, Amy E; Malhiot, Alex; Kostovich, Carol T; LaVela, Sherri L; Stroupe, Kevin; Gerber, Ben S; Burkhart, Lisa; Weiner, Saul J; Weaver, Frances M

    2017-09-01

    "Patient context" indicates patient circumstances and characteristics or states that are essential to address when planning patient care. Specific patient "contextual factors," if overlooked, result in an inappropriate plan of care, a medical error termed a "contextual error." The myriad contextual factors that constitute patient context have been grouped into broad domains to create a taxonomy of challenges to consider when planning care. This study sought to validate a previously identified list of contextual domains. This qualitative study used directed content analysis. In 2014, 19 Department of Veterans Affairs (VA) providers (84% female) and 49 patients (86% male) from two VA medical centers and four outpatient clinics in the Chicago area participated in semistructured interviews and focus groups. Topics included patient-specific, community, and resource-related factors that affect patients' abilities to manage their care. Transcripts were analyzed with a previously identified list of contextual domains as a framework. Analysis of responses revealed that patients and providers identified the same 10 domains previously published, plus 3 additional ones. Based on comments made by patients and providers, the authors created a revised list of 12 domains from themes that emerged. Six pertain to patient circumstances such as access to care and financial situation, and 6 to patient characteristics/states including skills, abilities, and knowledge. Contextual factors in patients' lives may be essential to address for effective care planning. The rubric developed can serve as a "contextual differential" for clinicians to consider when addressing challenges patients face when planning their care.

  6. Set-up error in supine-positioned patients immobilized with two different modalities during conformal radiotherapy of prostate cancer

    International Nuclear Information System (INIS)

    Fiorino, C.; Cattaneo, G.M.; Calandrino, R.; Reni, M.; Bolognesi, A.; Bonini, A.

    1998-01-01

    Background: Conformal radiotherapy requires reduced margins around the clinical target volume (CTV) with respect to traditional radiotherapy techniques. Therefore, high set-up accuracy and reproducibility are mandatory. Purpose: To investigate the effectiveness of two different immobilization techniques during conformal radiotherapy of prostate cancer with small fields. Materials and methods: 52 patients with prostate cancer were treated by conformal three- or four-field techniques with radical or adjuvant intent between November 1996 and March 1998. In total, 539 portal images were collected on a weekly basis for at least the first 4 weeks of the treatment on lateral and anterior 18 MV X-ray fields. The average number of sessions monitored per patient was 5.7 (range 4-10). All patients were immobilized with an alpha-cradle system; 25 of them were immobilized at the pelvis level (group A) and the remaining 27 patients were immobilized in the legs (group B). The shifts with respect to the simulation condition were assessed by measuring the distances between the same bony landmarks and the field edges. The global distributions of cranio-caudal (CC), posterior-anterior (PA) and left-right (LR) shifts were considered; for each patient random and systematic error components were assessed by following the procedure suggested by Bijhold et al. (Bijhold J, Lebesque JV, Hart AAM, Vijlbrief RE. Maximising set-up accuracy using portal images as applied to a conformal boost technique for prostatic cancer. Radiother. Oncol. 1992;24:261-271). For each patient the average isocentre (3D) shift was assessed as the quadratic sum of the average shifts in the three directions. Results 5 mm equal to 4.4% with respect to the 21.6% of group A (P<0.0001). This value was also better than the corresponding value found in a previously investigated group of 21 non-immobilized patients (Italia C, Fiorino C, Ciocca M, et al. Quality control by portal film analysis of the conformal radiotherapy

  7. Patient- and Provider-Centered Design of an Outpatient Diabetes Technology Clinic

    OpenAIRE

    Cramer, Angela M.; Scalzo, Patricia; Bach, Sarah M.; Kudva, Yogish C.

    2016-01-01

    The number of US patients using diabetes technology is increasing, and sophisticated technologies continue to emerge. Patients using diabetes technology require access to providers prepared to offer care in this rapidly changing field. The authors sought to identify factors important to both patients using diabetes technology and providers caring for such patients. They redesigned the Diabetes Technology Clinic at an academic group practice in response to the needs of patients and providers. ...

  8. Applications of aerospace technology in biomedicine. A technology transfer profile: Patient monitoring

    Science.gov (United States)

    Murray, D. M.

    1971-01-01

    NASA contributions to cardiovascular monitoring are described along with innovations in intracardiac blood pressure monitoring. A brief overview of the process of NASA technology transfer in patient monitoring is presented and a list of bioinstrumentation tech briefs and the number of requests for technical support is included.

  9. Learning curves, taking instructions, and patient safety: using a theoretical domains framework in an interview study to investigate prescribing errors among trainee doctors

    Directory of Open Access Journals (Sweden)

    Duncan Eilidh M

    2012-09-01

    Full Text Available Abstract Background Prescribing errors are a major source of morbidity and mortality and represent a significant patient safety concern. Evidence suggests that trainee doctors are responsible for most prescribing errors. Understanding the factors that influence prescribing behavior may lead to effective interventions to reduce errors. Existing investigations of prescribing errors have been based on Human Error Theory but not on other relevant behavioral theories. The aim of this study was to apply a broad theory-based approach using the Theoretical Domains Framework (TDF to investigate prescribing in the hospital context among a sample of trainee doctors. Method Semistructured interviews, based on 12 theoretical domains, were conducted with 22 trainee doctors to explore views, opinions, and experiences of prescribing and prescribing errors. Content analysis was conducted, followed by applying relevance criteria and a novel stage of critical appraisal, to identify which theoretical domains could be targeted in interventions to improve prescribing. Results Seven theoretical domains met the criteria of relevance: “social professional role and identity,” “environmental context and resources,” “social influences,” “knowledge,” “skills,” “memory, attention, and decision making,” and “behavioral regulation.” From critical appraisal of the interview data, “beliefs about consequences” and “beliefs about capabilities” were also identified as potentially important domains. Interrelationships between domains were evident. Additionally, the data supported theoretical elaboration of the domain behavioral regulation. Conclusions In this investigation of hospital-based prescribing, participants’ attributions about causes of errors were used to identify domains that could be targeted in interventions to improve prescribing. In a departure from previous TDF practice, critical appraisal was used to identify additional domains

  10. Learning curves, taking instructions, and patient safety: using a theoretical domains framework in an interview study to investigate prescribing errors among trainee doctors.

    Science.gov (United States)

    Duncan, Eilidh M; Francis, Jill J; Johnston, Marie; Davey, Peter; Maxwell, Simon; McKay, Gerard A; McLay, James; Ross, Sarah; Ryan, Cristín; Webb, David J; Bond, Christine

    2012-09-11

    Prescribing errors are a major source of morbidity and mortality and represent a significant patient safety concern. Evidence suggests that trainee doctors are responsible for most prescribing errors. Understanding the factors that influence prescribing behavior may lead to effective interventions to reduce errors. Existing investigations of prescribing errors have been based on Human Error Theory but not on other relevant behavioral theories. The aim of this study was to apply a broad theory-based approach using the Theoretical Domains Framework (TDF) to investigate prescribing in the hospital context among a sample of trainee doctors. Semistructured interviews, based on 12 theoretical domains, were conducted with 22 trainee doctors to explore views, opinions, and experiences of prescribing and prescribing errors. Content analysis was conducted, followed by applying relevance criteria and a novel stage of critical appraisal, to identify which theoretical domains could be targeted in interventions to improve prescribing. Seven theoretical domains met the criteria of relevance: "social professional role and identity," "environmental context and resources," "social influences," "knowledge," "skills," "memory, attention, and decision making," and "behavioral regulation." From critical appraisal of the interview data, "beliefs about consequences" and "beliefs about capabilities" were also identified as potentially important domains. Interrelationships between domains were evident. Additionally, the data supported theoretical elaboration of the domain behavioral regulation. In this investigation of hospital-based prescribing, participants' attributions about causes of errors were used to identify domains that could be targeted in interventions to improve prescribing. In a departure from previous TDF practice, critical appraisal was used to identify additional domains that should also be targeted, despite participants' perceptions that they were not relevant to

  11. Recognizing nurse stakeholder dissonance as a critical determinant of patient safety in new healthcare information technologies.

    Science.gov (United States)

    Samaras, Elizabeth A; Real, Sara D; Curtis, Amber M; Meunier, Tessa S

    2012-01-01

    Proper identification of all stakeholders and the comprehensive assessment of their evolving and often conflicting Needs, Wants, and Desires (NWDs) is a fundamental principle of human factors science and human-centered systems engineering; it is not yet a consistent element in development and deployment of new health information technologies (HIT). As the single largest group of healthcare professionals, nurses are critical stakeholders for these new technologies. Careful analysis can reveal nurse stakeholder dissonance (NSD) when integrating new technologies into the healthcare environment. Stakeholder dissonance is a term that describes the conflict between the NWDs of different stakeholders which, if left unresolved, can result in dissatisfaction, workarounds, errors, and threats to patient safety. Three case studies drawn from the authors' experience in a variety of acute-care settings where new HITs have been recently deployed are examined to illustrate the concept of NSD. Conflicting NWDs, other stakeholders, and possible root causes of the NSD are analyzed and mapped to threats to patient safety. Lessons learned, practical guidance for anticipating, identifying, and mitigating NSD, future research and implications for HFE and nursing practice are discussed.

  12. Enabling technologies promise to revitalize the role of nursing in an era of patient safety.

    Science.gov (United States)

    Ball, Marion J; Weaver, Charlotte; Abbott, Patricia A

    2003-01-01

    The application of information technology (IT) in health care has the potential to transform the delivery of care, as well as the health care work environment, by streamlining processes, making procedures more accurate and efficient, and reducing the risk of human error. For nurses, a major aspect of this transformation is the refocusing of their work on direct patient care and away from being a conduit of information and communication among departments. Several of the technologies discussed, such as physician order entry and bar code technology, have existed for years as standalone systems. Many others are just being developed and are being integrated into complex clinical information systems (CISs) with clinical decision support at their core. While early evaluation of these systems shows positive outcome measurements, financial, technical, and organizational hurdles to widespread implementation still remain. One major issue is defining the role nurses, themselves, will play in the selection and implementation of these systems as they become more steeped in the knowledge of nursing informatics. Other challenges revolve around issues of job satisfaction and the attraction and retention of nursing staff in the midst of a serious nursing shortage. Despite these concerns, it is expected that, in the long run, the creation of an electronic work environment with systems that integrate all functions of the health care team will positively impact cost-effectiveness, productivity, and patient safety while helping to revitalize nursing practice. Copyright 2002 Elsevier Science Ireland Ltd.

  13. Automated Patient Identification and Localization Error Detection Using 2-Dimensional to 3-Dimensional Registration of Kilovoltage X-Ray Setup Images

    International Nuclear Information System (INIS)

    Lamb, James M.; Agazaryan, Nzhde; Low, Daniel A.

    2013-01-01

    Purpose: To determine whether kilovoltage x-ray projection radiation therapy setup images could be used to perform patient identification and detect gross errors in patient setup using a computer algorithm. Methods and Materials: Three patient cohorts treated using a commercially available image guided radiation therapy (IGRT) system that uses 2-dimensional to 3-dimensional (2D-3D) image registration were retrospectively analyzed: a group of 100 cranial radiation therapy patients, a group of 100 prostate cancer patients, and a group of 83 patients treated for spinal lesions. The setup images were acquired using fixed in-room kilovoltage imaging systems. In the prostate and cranial patient groups, localizations using image registration were performed between computed tomography (CT) simulation images from radiation therapy planning and setup x-ray images corresponding both to the same patient and to different patients. For the spinal patients, localizations were performed to the correct vertebral body, and to an adjacent vertebral body, using planning CTs and setup x-ray images from the same patient. An image similarity measure used by the IGRT system image registration algorithm was extracted from the IGRT system log files and evaluated as a discriminant for error detection. Results: A threshold value of the similarity measure could be chosen to separate correct and incorrect patient matches and correct and incorrect vertebral body localizations with excellent accuracy for these patient cohorts. A 10-fold cross-validation using linear discriminant analysis yielded misclassification probabilities of 0.000, 0.0045, and 0.014 for the cranial, prostate, and spinal cases, respectively. Conclusions: An automated measure of the image similarity between x-ray setup images and corresponding planning CT images could be used to perform automated patient identification and detection of localization errors in radiation therapy treatments

  14. Automated Patient Identification and Localization Error Detection Using 2-Dimensional to 3-Dimensional Registration of Kilovoltage X-Ray Setup Images

    Energy Technology Data Exchange (ETDEWEB)

    Lamb, James M., E-mail: jlamb@mednet.ucla.edu; Agazaryan, Nzhde; Low, Daniel A.

    2013-10-01

    Purpose: To determine whether kilovoltage x-ray projection radiation therapy setup images could be used to perform patient identification and detect gross errors in patient setup using a computer algorithm. Methods and Materials: Three patient cohorts treated using a commercially available image guided radiation therapy (IGRT) system that uses 2-dimensional to 3-dimensional (2D-3D) image registration were retrospectively analyzed: a group of 100 cranial radiation therapy patients, a group of 100 prostate cancer patients, and a group of 83 patients treated for spinal lesions. The setup images were acquired using fixed in-room kilovoltage imaging systems. In the prostate and cranial patient groups, localizations using image registration were performed between computed tomography (CT) simulation images from radiation therapy planning and setup x-ray images corresponding both to the same patient and to different patients. For the spinal patients, localizations were performed to the correct vertebral body, and to an adjacent vertebral body, using planning CTs and setup x-ray images from the same patient. An image similarity measure used by the IGRT system image registration algorithm was extracted from the IGRT system log files and evaluated as a discriminant for error detection. Results: A threshold value of the similarity measure could be chosen to separate correct and incorrect patient matches and correct and incorrect vertebral body localizations with excellent accuracy for these patient cohorts. A 10-fold cross-validation using linear discriminant analysis yielded misclassification probabilities of 0.000, 0.0045, and 0.014 for the cranial, prostate, and spinal cases, respectively. Conclusions: An automated measure of the image similarity between x-ray setup images and corresponding planning CT images could be used to perform automated patient identification and detection of localization errors in radiation therapy treatments.

  15. Automated patient identification and localization error detection using 2-dimensional to 3-dimensional registration of kilovoltage x-ray setup images.

    Science.gov (United States)

    Lamb, James M; Agazaryan, Nzhde; Low, Daniel A

    2013-10-01

    To determine whether kilovoltage x-ray projection radiation therapy setup images could be used to perform patient identification and detect gross errors in patient setup using a computer algorithm. Three patient cohorts treated using a commercially available image guided radiation therapy (IGRT) system that uses 2-dimensional to 3-dimensional (2D-3D) image registration were retrospectively analyzed: a group of 100 cranial radiation therapy patients, a group of 100 prostate cancer patients, and a group of 83 patients treated for spinal lesions. The setup images were acquired using fixed in-room kilovoltage imaging systems. In the prostate and cranial patient groups, localizations using image registration were performed between computed tomography (CT) simulation images from radiation therapy planning and setup x-ray images corresponding both to the same patient and to different patients. For the spinal patients, localizations were performed to the correct vertebral body, and to an adjacent vertebral body, using planning CTs and setup x-ray images from the same patient. An image similarity measure used by the IGRT system image registration algorithm was extracted from the IGRT system log files and evaluated as a discriminant for error detection. A threshold value of the similarity measure could be chosen to separate correct and incorrect patient matches and correct and incorrect vertebral body localizations with excellent accuracy for these patient cohorts. A 10-fold cross-validation using linear discriminant analysis yielded misclassification probabilities of 0.000, 0.0045, and 0.014 for the cranial, prostate, and spinal cases, respectively. An automated measure of the image similarity between x-ray setup images and corresponding planning CT images could be used to perform automated patient identification and detection of localization errors in radiation therapy treatments. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. CORRELATION OF FUNDUS CHANGES IN RELATION TO REFRACTIVE ERROR IN PATIENTS WITH MYOPIA- A CLINICAL PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Balasubramanian M. Manickavelu

    2018-01-01

    Full Text Available BACKGROUND Retina is unique among the complex element of the central nervous system and the special senses. It may be readily viewed during life and it is sufficiently transparent, so that alterations within and adjacent to it may be observed in vivo. The peripheral retina owing to its thinness comparing to that of the central part, poorly-developed retinal cells, absence of large blood vessels, relatively insensitive to light, less resistance to traction, forms a seat for various lesions, which are potentially dangerous for the vision. It is in myopia that we meet the most frequent and the most obvious anomalies in the fundus changes, which bear some relation to the degree of myopia and appeal to be concerned with it either as a cause or effect or perhaps both. The aim of our study is to correlate fundus changes in relation to refractive error in patients with myopia. MATERIALS AND METHODS In our study, 100 cases of myopic (-6D:50 cases patients were selected. Detailed evaluation done. History of refractive error includes duration, age at which spectacles were worn for the first time. Time of last change of spectacles, family history of myopia, history of other symptoms like progressive loss of vision, defective vision related to day or night, sudden loss of vision, flashes and floaters. Anterior segment was examined followed by the recording of initial visual acuity and the best corrected visual acuity was noted. IOP was measured for all the cases using Schiotz tonometry. Axial length was measured in all the cases. Fundus examined with direct ophthalmoscope, indirect ophthalmoscope, 3 mirror and 90D lens. Bscan was done in few cases. The media, disc, vessels, macula and the surrounding retina were examined. The periphery was examined with indentation method. The various fundus features and pathological lesions in different degrees of myopia were noted. RESULTS Females were comparatively more affected. Highest incidence was seen in the younger

  17. Apologies and Medical Error

    Science.gov (United States)

    2008-01-01

    One way in which physicians can respond to a medical error is to apologize. Apologies—statements that acknowledge an error and its consequences, take responsibility, and communicate regret for having caused harm—can decrease blame, decrease anger, increase trust, and improve relationships. Importantly, apologies also have the potential to decrease the risk of a medical malpractice lawsuit and can help settle claims by patients. Patients indicate they want and expect explanations and apologies after medical errors and physicians indicate they want to apologize. However, in practice, physicians tend to provide minimal information to patients after medical errors and infrequently offer complete apologies. Although fears about potential litigation are the most commonly cited barrier to apologizing after medical error, the link between litigation risk and the practice of disclosure and apology is tenuous. Other barriers might include the culture of medicine and the inherent psychological difficulties in facing one’s mistakes and apologizing for them. Despite these barriers, incorporating apology into conversations between physicians and patients can address the needs of both parties and can play a role in the effective resolution of disputes related to medical error. PMID:18972177

  18. Effect of fatigue on landing performance assessed with the landing error scoring system (less) in patients after ACL reconstruction. A pilot study

    NARCIS (Netherlands)

    Gokeler, A; Eppinga, P; Dijkstra, P U; Welling, Wouter; Padua, D A; Otten, E.; Benjaminse, A

    BACKGROUND: Fatigue has been shown to affect performance of hop tests in patients after anterior cruciate ligament reconstruction (ACLR) compared to uninjured controls (CTRL). This may render the hop test less sensitive in detecting landing errors. The primary purpose of this study was to

  19. On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study

    NARCIS (Netherlands)

    Klopotowska, J.E.; Kuiper, R.; van Kan, H.J.; de Pont, A.C.; Dijkgraaf, M.G.; Lie-A-Huen, L.; Vroom, M.B.; Smorenburg, S.M.

    2010-01-01

    Introduction: Patients admitted to an intensive care unit (ICU) are at high risk for prescribing errors and related adverse drug events (ADEs). An effective intervention to decrease this risk, based on studies conducted mainly in North America, is on-ward participation of a clinical pharmacist in an

  20. On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study

    NARCIS (Netherlands)

    Klopotowska, Joanna E.; Kuiper, Rob; van Kan, Hendrikus J.; de Pont, Anne-Cornelie; Dijkgraaf, Marcel G.; Lie-A-Huen, Loraine; Vroom, Margreeth B.; Smorenburg, Susanne M.

    2010-01-01

    Patients admitted to an intensive care unit (ICU) are at high risk for prescribing errors and related adverse drug events (ADEs). An effective intervention to decrease this risk, based on studies conducted mainly in North America, is on-ward participation of a clinical pharmacist in an ICU team. As

  1. Utilizing information technologies for lifelong monitoring in diabetes patients.

    Science.gov (United States)

    Capozzi, Davide; Lanzola, Giordano

    2011-01-01

    Information and communication technologies have long been acknowledged to support information sharing along the whole chain of care, from the clinic to the homes of patients and their relatives. Thus they are increasingly being considered for improving the delivery of health care services also in light of clinical and technological achievements that propose new treatments requiring a tighter interaction among patients and physicians. The multiagent paradigm has been utilized within an architecture for delivering telemedicine services to chronic outpatients at their domiciles and enforcing cooperation among patients, caregivers, and different members of the health care staff. The architecture sees each communication device such as a palmtop, smart phone, or personal digital assistant as a separate agent upon which different services are deployed, including telemetry, reminders, notifications, and alarms. Decoupling services from agents account for a highly configurable environment applicable to almost any context that can be customized as needed. The architecture has been used for designing and implementing a prototypical software infrastructure, called LifePhone, that runs on several communication devices. A basic set of services has been devised with which we were able to configure two different applications that address long-term and short-term monitoring scenarios for diabetes patients. The long-term scenario encompasses telemetry and reminder services for patients undergoing peritoneal dialysis, which is a treatment for chronic renal failure, a diabetes complication. The short-term scenario incorporates telemetry and remote alarms and is applicable for training patients to use an artificial pancreas. Our experiments proved that an infrastructure such as LifePhone can be used successfully for bridging the interaction gap that exists among all the components of a health care delivery process, improving the quality of service and possibly reducing the overall

  2. MO-FG-BRA-06: Electromagnetic Beacon Insertion in Lung Cancer Patients and Resultant Surrogacy Errors for Dynamic MLC Tumour Tracking

    Energy Technology Data Exchange (ETDEWEB)

    Hardcastle, N; Booth, J; Caillet, V; Haddad, C; Crasta, C [Royal North Shore Hospital, St. Leonards, NSW (Australia); O’Brien, R; Keall, P [University of Sydney, Sydney, NSW (Australia); Szymura, K [Royal North Shore Hospital, Sydney, NSW (Australia)

    2016-06-15

    Purpose: To assess endo-bronchial electromagnetic beacon insertion and to quantify the geometric accuracy of using beacons as a surrogate for tumour motion in real-time multileaf collimator (MLC) tracking of lung tumours. Methods: The LIGHT SABR trial is a world-first clinical trial in which the MLC leaves move with lung tumours in real time on a standard linear accelerator. Tracking is performed based on implanted electromagnetic beacons (CalypsoTM, Varian Medical Systems, USA) as a surrogate for tumour motion. Five patients have been treated and have each had three beacons implanted endo-bronchially under fluoroscopic guidance. The centre of mass (C.O.M) has been used to adapt the MLC in real-time. The geometric error in using the beacon C.O.M as a surrogate for tumour motion was measured by measuring the tumour and beacon C.O.M in all phases of the respiratory cycle of a 4DCT. The surrogacy error was defined as the difference in beacon and tumour C.O.M relative to the reference phase (maximum exhale). Results: All five patients have had three beacons successfully implanted with no migration between simulation and end of treatment. Beacon placement relative to tumour C.O.M varied from 14 to 74 mm and in one patient spanned two lobes. Surrogacy error was measured in each patient on the simulation 4DCT and ranged from 0 to 3 mm. Surrogacy error as measured on 4DCT was subject to artefacts in mid-ventilation phases. Surrogacy error was a function of breathing phase and was typically larger at maximum inhale. Conclusion: Beacon placement and thus surrogacy error is a major component of geometric uncertainty in MLC tracking of lung tumours. Surrogacy error must be measured on each patient and incorporated into margin calculation. Reduction of surrogacy error is limited by airway anatomy, however should be taken into consideration when performing beacon insertion and planning. This research is funded by Varian Medical Systems via a collaborative research agreement.

  3. MO-FG-BRA-06: Electromagnetic Beacon Insertion in Lung Cancer Patients and Resultant Surrogacy Errors for Dynamic MLC Tumour Tracking

    International Nuclear Information System (INIS)

    Hardcastle, N; Booth, J; Caillet, V; Haddad, C; Crasta, C; O’Brien, R; Keall, P; Szymura, K

    2016-01-01

    Purpose: To assess endo-bronchial electromagnetic beacon insertion and to quantify the geometric accuracy of using beacons as a surrogate for tumour motion in real-time multileaf collimator (MLC) tracking of lung tumours. Methods: The LIGHT SABR trial is a world-first clinical trial in which the MLC leaves move with lung tumours in real time on a standard linear accelerator. Tracking is performed based on implanted electromagnetic beacons (CalypsoTM, Varian Medical Systems, USA) as a surrogate for tumour motion. Five patients have been treated and have each had three beacons implanted endo-bronchially under fluoroscopic guidance. The centre of mass (C.O.M) has been used to adapt the MLC in real-time. The geometric error in using the beacon C.O.M as a surrogate for tumour motion was measured by measuring the tumour and beacon C.O.M in all phases of the respiratory cycle of a 4DCT. The surrogacy error was defined as the difference in beacon and tumour C.O.M relative to the reference phase (maximum exhale). Results: All five patients have had three beacons successfully implanted with no migration between simulation and end of treatment. Beacon placement relative to tumour C.O.M varied from 14 to 74 mm and in one patient spanned two lobes. Surrogacy error was measured in each patient on the simulation 4DCT and ranged from 0 to 3 mm. Surrogacy error as measured on 4DCT was subject to artefacts in mid-ventilation phases. Surrogacy error was a function of breathing phase and was typically larger at maximum inhale. Conclusion: Beacon placement and thus surrogacy error is a major component of geometric uncertainty in MLC tracking of lung tumours. Surrogacy error must be measured on each patient and incorporated into margin calculation. Reduction of surrogacy error is limited by airway anatomy, however should be taken into consideration when performing beacon insertion and planning. This research is funded by Varian Medical Systems via a collaborative research agreement.

  4. Patient safety and technology-driven medication e A qualitative study on how graduate nursing students navigate through complex medication administration

    DEFF Research Database (Denmark)

    Orbæk, Janne; Gaard, Mette; Fabricius, Pia

    2014-01-01

    ways of educating nursing students in today's medication administration. Aim: To explore nursing students' experiences and competences with the technology-driven medication administration process. Methods: 16 pre-graduate nursing students were included in two focus group interviews which were recorded...... for the technology-driven medication process, nursing students face difficulties in identifying and adopting best practices. The impact of using technology on the frequency, type and severity of medication errors; the technologies implications on nursing professionalism and the nurses ability to secure patient...

  5. [Efficacy of motivational interviewing for reducing medication errors in chronic patients over 65 years with polypharmacy: Results of a cluster randomized trial].

    Science.gov (United States)

    Pérula de Torres, Luis Angel; Pulido Ortega, Laura; Pérula de Torres, Carlos; González Lama, Jesús; Olaya Caro, Inmaculada; Ruiz Moral, Roger

    2014-10-21

    To evaluate the effectiveness of an intervention based on motivational interviewing to reduce medication errors in chronic patients over 65 with polypharmacy. Cluster randomized trial that included doctors and nurses of 16 Primary Care centers and chronic patients with polypharmacy over 65 years. The professionals were assigned to the experimental or the control group using stratified randomization. Interventions consisted of training of professionals and revision of patient treatments, application of motivational interviewing in the experimental group and also the usual approach in the control group. The primary endpoint (medication error) was analyzed at individual level, and was estimated with the absolute risk reduction (ARR), relative risk reduction (RRR), number of subjects to treat (NNT) and by multiple logistic regression analysis. Thirty-two professionals were randomized (19 doctors and 13 nurses), 27 of them recruited 154 patients consecutively (13 professionals in the experimental group recruited 70 patients and 14 professionals recruited 84 patients in the control group) and completed 6 months of follow-up. The mean age of patients was 76 years (68.8% women). A decrease in the average of medication errors was observed along the period. The reduction was greater in the experimental than in the control group (F=5.109, P=.035). RRA 29% (95% confidence interval [95% CI] 15.0-43.0%), RRR 0.59 (95% CI:0.31-0.76), and NNT 3.5 (95% CI 2.3-6.8). Motivational interviewing is more efficient than the usual approach to reduce medication errors in patients over 65 with polypharmacy. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  6. Improving patient access to novel medical technologies in Europe.

    LENUS (Irish Health Repository)

    Kearney, Peter

    2012-02-03

    The European Society of Cardiology (ESC) organized a one-day workshop with clinicians, health economic experts, and health technology appraisal experts to discuss the equity of patient access to novel medical technologies in Europe. Two index technologies were considered: implantable cardioverter defibrillators (ICDs) and drug-eluting stents (DES). The use of ICDs range from 35 implants\\/million population in Portugal to 166 implants\\/million population in Germany, whereas for implants of DES (as percentage of total stents) it is lowest in Germany at 14% and high in Portugal at 65%. These differences can in part be explained by a lack of structured implementation of guidelines, the direct cost in relation to the overall healthcare budget, and to differences in procedures and models applied by Health Technology Assessment (HTA) agencies in Europe. The workshop participants concluded that physicians need to be involved in a more structured way in HTA and need to become better acquainted with its methods and terminology. Clinical guidelines should be systematically translated, explained, disseminated, updated, and adopted by cardiologists in Europe. Clinically appropriate, consistent and transparent health economic models need to be developed and high-quality international outcome and cost data should be used. A process for funding of a technology should be developed after a positive recommendation from HTA agencies. Both the ESC and the national cardiac societies should build-up health economic expertise and engage more actively in discussions with stakeholders involved in the provision of healthcare.

  7. Measuring uncertainty in dose delivered to the cochlea due to setup error during external beam treatment of patients with cancer of the head and neck

    Energy Technology Data Exchange (ETDEWEB)

    Yan, M.; Lovelock, D.; Hunt, M.; Mechalakos, J.; Hu, Y.; Pham, H.; Jackson, A., E-mail: jacksona@mskcc.org [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York 10065 (United States)

    2013-12-15

    Purpose: To use Cone Beam CT scans obtained just prior to treatments of head and neck cancer patients to measure the setup error and cumulative dose uncertainty of the cochlea. Methods: Data from 10 head and neck patients with 10 planning CTs and 52 Cone Beam CTs taken at time of treatment were used in this study. Patients were treated with conventional fractionation using an IMRT dose painting technique, most with 33 fractions. Weekly radiographic imaging was used to correct the patient setup. The authors used rigid registration of the planning CT and Cone Beam CT scans to find the translational and rotational setup errors, and the spatial setup errors of the cochlea. The planning CT was rotated and translated such that the cochlea positions match those seen in the cone beam scans, cochlea doses were recalculated and fractional doses accumulated. Uncertainties in the positions and cumulative doses of the cochlea were calculated with and without setup adjustments from radiographic imaging. Results: The mean setup error of the cochlea was 0.04 ± 0.33 or 0.06 ± 0.43 cm for RL, 0.09 ± 0.27 or 0.07 ± 0.48 cm for AP, and 0.00 ± 0.21 or −0.24 ± 0.45 cm for SI with and without radiographic imaging, respectively. Setup with radiographic imaging reduced the standard deviation of the setup error by roughly 1–2 mm. The uncertainty of the cochlea dose depends on the treatment plan and the relative positions of the cochlea and target volumes. Combining results for the left and right cochlea, the authors found the accumulated uncertainty of the cochlea dose per fraction was 4.82 (0.39–16.8) cGy, or 10.1 (0.8–32.4) cGy, with and without radiographic imaging, respectively; the percentage uncertainties relative to the planned doses were 4.32% (0.28%–9.06%) and 10.2% (0.7%–63.6%), respectively. Conclusions: Patient setup error introduces uncertainty in the position of the cochlea during radiation treatment. With the assistance of radiographic imaging during setup

  8. Local setup errors in image-guided radiotherapy for head and neck cancer patients immobilized with a custom-made device.

    Science.gov (United States)

    Giske, Kristina; Stoiber, Eva M; Schwarz, Michael; Stoll, Armin; Muenter, Marc W; Timke, Carmen; Roeder, Falk; Debus, Juergen; Huber, Peter E; Thieke, Christian; Bendl, Rolf

    2011-06-01

    To evaluate the local positioning uncertainties during fractionated radiotherapy of head-and-neck cancer patients immobilized using a custom-made fixation device and discuss the effect of possible patient correction strategies for these uncertainties. A total of 45 head-and-neck patients underwent regular control computed tomography scanning using an in-room computed tomography scanner. The local and global positioning variations of all patients were evaluated by applying a rigid registration algorithm. One bounding box around the complete target volume and nine local registration boxes containing relevant anatomic structures were introduced. The resulting uncertainties for a stereotactic setup and the deformations referenced to one anatomic local registration box were determined. Local deformations of the patients immobilized using our custom-made device were compared with previously published results. Several patient positioning correction strategies were simulated, and the residual local uncertainties were calculated. The patient anatomy in the stereotactic setup showed local systematic positioning deviations of 1-4 mm. The deformations referenced to a particular anatomic local registration box were similar to the reported deformations assessed from patients immobilized with commercially available Aquaplast masks. A global correction, including the rotational error compensation, decreased the remaining local translational errors. Depending on the chosen patient positioning strategy, the remaining local uncertainties varied considerably. Local deformations in head-and-neck patients occur even if an elaborate, custom-made patient fixation method is used. A rotational error correction decreased the required margins considerably. None of the considered correction strategies achieved perfect alignment. Therefore, weighting of anatomic subregions to obtain the optimal correction vector should be investigated in the future. Copyright © 2011 Elsevier Inc. All rights

  9. Free and open source enabling technologies for patient-centric, guideline-based clinical decision support: a survey.

    Science.gov (United States)

    Leong, T Y; Kaiser, K; Miksch, S

    2007-01-01

    Guideline-based clinical decision support is an emerging paradigm to help reduce error, lower cost, and improve quality in evidence-based medicine. The free and open source (FOS) approach is a promising alternative for delivering cost-effective information technology (IT) solutions in health care. In this paper, we survey the current FOS enabling technologies for patient-centric, guideline-based care, and discuss the current trends and future directions of their role in clinical decision support. We searched PubMed, major biomedical informatics websites, and the web in general for papers and links related to FOS health care IT systems. We also relied on our background and knowledge for specific subtopics. We focused on the functionalities of guideline modeling tools, and briefly examined the supporting technologies for terminology, data exchange and electronic health record (EHR) standards. To effectively support patient-centric, guideline-based care, the computerized guidelines and protocols need to be integrated with existing clinical information systems or EHRs. Technologies that enable such integration should be accessible, interoperable, and scalable. A plethora of FOS tools and techniques for supporting different knowledge management and quality assurance tasks involved are available. Many challenges, however, remain in their implementation. There are active and growing trends of deploying FOS enabling technologies for integrating clinical guidelines, protocols, and pathways into the main care processes. The continuing development and maturation of such technologies are likely to make increasingly significant contributions to patient-centric, guideline-based clinical decision support.

  10. Evaluating a medical error taxonomy.

    OpenAIRE

    Brixey, Juliana; Johnson, Todd R.; Zhang, Jiajie

    2002-01-01

    Healthcare has been slow in using human factors principles to reduce medical errors. The Center for Devices and Radiological Health (CDRH) recognizes that a lack of attention to human factors during product development may lead to errors that have the potential for patient injury, or even death. In response to the need for reducing medication errors, the National Coordinating Council for Medication Errors Reporting and Prevention (NCC MERP) released the NCC MERP taxonomy that provides a stand...

  11. Characteristics and evidence of nursing scientific production for medication errors at the hospital environment

    Directory of Open Access Journals (Sweden)

    Lolita Dopico da Silva

    2012-06-01

    Full Text Available This study aimed to identify the characteristics of nurses’ publications about medication errors. It was used an Integrative methodology review covering January 2005 to October 2010 with "medication errors" and "nursing" descriptors and it was also collected data from electronic databases via “Capes Portal”. Results show four categories, the conduct of health professionals in medication errors, types and rates of errors, medication system weaknesses, and barriers to error. Discussion of the prevalent practice was not to notify the error. The prevalent error type was administration and error rates which ranged from 14.8 to 56.7%. Ilegible handwriting, communication failures among professionals, and lack of technical knowledge were weaknesses. Among the barriers, the civility from patient, nurses and technology were evident. Advances in researches for testing barriers were found and some gaps were apparent concerning lack of study that address pharmacodynamics or pharmacokinetic aspects of drugs involved in errors.

  12. Labview Based ECG Patient Monitoring System for Cardiovascular Patient Using SMTP Technology.

    Science.gov (United States)

    Singh, Om Prakash; Mekonnen, Dawit; Malarvili, M B

    2015-01-01

    This paper leads to developing a Labview based ECG patient monitoring system for cardiovascular patient using Simple Mail Transfer Protocol technology. The designed device has been divided into three parts. First part is ECG amplifier circuit, built using instrumentation amplifier (AD620) followed by signal conditioning circuit with the operation amplifier (lm741). Secondly, the DAQ card is used to convert the analog signal into digital form for the further process. Furthermore, the data has been processed in Labview where the digital filter techniques have been implemented to remove the noise from the acquired signal. After processing, the algorithm was developed to calculate the heart rate and to analyze the arrhythmia condition. Finally, SMTP technology has been added in our work to make device more communicative and much more cost-effective solution in telemedicine technology which has been key-problem to realize the telediagnosis and monitoring of ECG signals. The technology also can be easily implemented over already existing Internet.

  13. Error-Free Software

    Science.gov (United States)

    1989-01-01

    001 is an integrated tool suited for automatically developing ultra reliable models, simulations and software systems. Developed and marketed by Hamilton Technologies, Inc. (HTI), it has been applied in engineering, manufacturing, banking and software tools development. The software provides the ability to simplify the complex. A system developed with 001 can be a prototype or fully developed with production quality code. It is free of interface errors, consistent, logically complete and has no data or control flow errors. Systems can be designed, developed and maintained with maximum productivity. Margaret Hamilton, President of Hamilton Technologies, also directed the research and development of USE.IT, an earlier product which was the first computer aided software engineering product in the industry to concentrate on automatically supporting the development of an ultrareliable system throughout its life cycle. Both products originated in NASA technology developed under a Johnson Space Center contract.

  14. Error in the delivery of radiation therapy: Results of a quality assurance review

    International Nuclear Information System (INIS)

    Huang, Grace; Medlam, Gaylene; Lee, Justin; Billingsley, Susan; Bissonnette, Jean-Pierre; Ringash, Jolie; Kane, Gabrielle; Hodgson, David C.

    2005-01-01

    Purpose: To examine error rates in the delivery of radiation therapy (RT), technical factors associated with RT errors, and the influence of a quality improvement intervention on the RT error rate. Methods and materials: We undertook a review of all RT errors that occurred at the Princess Margaret Hospital (Toronto) from January 1, 1997, to December 31, 2002. Errors were identified according to incident report forms that were completed at the time the error occurred. Error rates were calculated per patient, per treated volume (≥1 volume per patient), and per fraction delivered. The association between tumor site and error was analyzed. Logistic regression was used to examine the association between technical factors and the risk of error. Results: Over the study interval, there were 555 errors among 28,136 patient treatments delivered (error rate per patient = 1.97%, 95% confidence interval [CI], 1.81-2.14%) and among 43,302 treated volumes (error rate per volume = 1.28%, 95% CI, 1.18-1.39%). The proportion of fractions with errors from July 1, 2000, to December 31, 2002, was 0.29% (95% CI, 0.27-0.32%). Patients with sarcoma or head-and-neck tumors experienced error rates significantly higher than average (5.54% and 4.58%, respectively); however, when the number of treated volumes was taken into account, the head-and-neck error rate was no longer higher than average (1.43%). The use of accessories was associated with an increased risk of error, and internal wedges were more likely to be associated with an error than external wedges (relative risk = 2.04; 95% CI, 1.11-3.77%). Eighty-seven errors (15.6%) were directly attributed to incorrect programming of the 'record and verify' system. Changes to planning and treatment processes aimed at reducing errors within the head-and-neck site group produced a substantial reduction in the error rate. Conclusions: Errors in the delivery of RT are uncommon and usually of little clinical significance. Patient subgroups and

  15. A systematic review of game technologies for pediatric patients.

    Science.gov (United States)

    Jurdi, Sandra; Montaner, Jorge; Garcia-Sanjuan, Fernando; Jaen, Javier; Nacher, Vicente

    2018-06-01

    Children in hospital are subjected to multiple negative stimuli that may hinder their development and social interactions. Although game technologies are thought to improve children's experience in hospital, there is a lack of information on how they can be used effectively. This paper presents a systematic review of the literature on the existing approaches in this context to identify gaps for future research. A total of 1305 studies were identified, of which 75 were thoroughly analyzed according to our review protocol. The results show that the most common approach is to design mono-user games with traditional computers or monitor-based video consoles, which serve as a distractor or a motivator for physical rehabilitation for primary school children undergoing fearful procedures such as venipuncture, or those suffering chronic, neurological, or traumatic diseases/injures. We conclude that, on the one hand, game technologies seem to present physical and psychological benefits to pediatric patients, but more research is needed on this. On the other hand, future designers of games for pediatric hospitalization should consider: 1. The development for kindergarten patients and adolescents, 2. Address the psychological impact caused by long-term hospitalization, 3. Use collaboration as an effective game strategy to reduce patient isolation, 4. Have purposes other than distraction, such as socialization, coping with emotions, or fostering physical mobility, 5. Include parents/caregivers and hospital staff in the game activities; and 6. Exploit new technological artifacts such as robots and tangible interactive elements to encourage intrinsic motivation. Copyright © 2018 Elsevier Ltd. All rights reserved.

  16. Modern computer technologies facilitate communication with a young cancer patient.

    Science.gov (United States)

    Ripamonti, Carla Ida; Piccinelli, Claudia; Pessi, Maria Adelaide; Clerici, Carlo Alfredo

    2010-01-01

    The aim of this paper is to show how new technologies may help the communication process in clinical practice in a department providing supportive care to patients undergoing cancer treatment. Communication via Internet chat between the psychologist and a young man who sees chatting on the Internet as a natural and familiar mode of expression was shown to be useful. The Internet link enabled us to open a communication channel with the patient and to have a conversation that would otherwise have been impossible. Although verbal communication is the most important way to communicate among people, Internet communications are certainly an opportunity worth exploring, because they may open up new channels for cancer patients whose ability to speak is restricted. We might imagine using this approach in pediatric oncology, with adolescents and preadolescents, and with young adults like the patient discussed here. The case discussed highlights the enormous difference between the mere transfer of information and genuine communication, the latter involving an encounter with the patient.

  17. [Supervised administration of Alzheimer's patients using information communication technology].

    Science.gov (United States)

    Noda, Yasuha; Sakata, Yoshifumi; Kubota, Masakazu; Uemura, Kengo; Kihara, Takeshi; Kimura, Toru; Ino, Masashi; Tsuji, Teruyuki; Hayashi, Michiyuki; Kinoshita, Ayae

    2014-12-01

    Drug adherence is central to the treatment of dementia, which might reduce compliance due to memory loss, particularly among home-based patients with dementia. In order to improve drug adherence, we suggest the efficient and effective supervised administration by use of information communication technology(ICT). ICT makes face-to-face real-time communication possible, and it also enables picture sharing. Therefore, it might be useful to apply ICT to controlling and supervising medication for patients with dementia to improve drug adherence. Accordingly, we enrolled patients who were supposed to take a newly prescribed anti-dementia patch containing the choline esterase inhibitor rivastigmine(Rivastach®)and investigated the effect of ICT-based intervention for drug adherence, emotional change, and cognitive change, utilizing Skype, a free communication software program. Scheduled Skype interventions increased drug adherence ratio, levels of subjective satisfaction, and instrumental activities of daily living(IADL). Furthermore, we can provide patients and their caregivers with a feeling of safety through regular bidirectional communication, as patients can easily consult medical staff regarding the adverse effects of newly prescribed drugs. Instead of frequent visits to their primary physicians, ICT-based communications can be used as a substitute for supervision of medication, given the availability of the telecommunication system. By directly connecting the medical institution to the home, we expect that this ICT-based system will expand into the geriatric care field, including the care of elderly individuals living alone.

  18. Imaging and dosimetric errors in 4D PET/CT-guided radiotherapy from patient-specific respiratory patterns: a dynamic motion phantom end-to-end study.

    Science.gov (United States)

    Bowen, S R; Nyflot, M J; Herrmann, C; Groh, C M; Meyer, J; Wollenweber, S D; Stearns, C W; Kinahan, P E; Sandison, G A

    2015-05-07

    Effective positron emission tomography / computed tomography (PET/CT) guidance in radiotherapy of lung cancer requires estimation and mitigation of errors due to respiratory motion. An end-to-end workflow was developed to measure patient-specific motion-induced uncertainties in imaging, treatment planning, and radiation delivery with respiratory motion phantoms and dosimeters. A custom torso phantom with inserts mimicking normal lung tissue and lung lesion was filled with [(18)F]FDG. The lung lesion insert was driven by six different patient-specific respiratory patterns or kept stationary. PET/CT images were acquired under motionless ground truth, tidal breathing motion-averaged (3D), and respiratory phase-correlated (4D) conditions. Target volumes were estimated by standardized uptake value (SUV) thresholds that accurately defined the ground-truth lesion volume. Non-uniform dose-painting plans using volumetrically modulated arc therapy were optimized for fixed normal lung and spinal cord objectives and variable PET-based target objectives. Resulting plans were delivered to a cylindrical diode array at rest, in motion on a platform driven by the same respiratory patterns (3D), or motion-compensated by a robotic couch with an infrared camera tracking system (4D). Errors were estimated relative to the static ground truth condition for mean target-to-background (T/Bmean) ratios, target volumes, planned equivalent uniform target doses, and 2%-2 mm gamma delivery passing rates. Relative to motionless ground truth conditions, PET/CT imaging errors were on the order of 10-20%, treatment planning errors were 5-10%, and treatment delivery errors were 5-30% without motion compensation. Errors from residual motion following compensation methods were reduced to 5-10% in PET/CT imaging, PET/CT imaging to RT planning, and RT delivery under a dose painting paradigm is feasible within an integrated respiratory motion phantom workflow. For a limited set of cases, the magnitude

  19. Imaging and dosimetric errors in 4D PET/CT-guided radiotherapy from patient-specific respiratory patterns: a dynamic motion phantom end-to-end study

    International Nuclear Information System (INIS)

    Bowen, S R; Nyflot, M J; Meyer, J; Sandison, G A; Herrmann, C; Groh, C M; Wollenweber, S D; Stearns, C W; Kinahan, P E

    2015-01-01

    Effective positron emission tomography / computed tomography (PET/CT) guidance in radiotherapy of lung cancer requires estimation and mitigation of errors due to respiratory motion. An end-to-end workflow was developed to measure patient-specific motion-induced uncertainties in imaging, treatment planning, and radiation delivery with respiratory motion phantoms and dosimeters. A custom torso phantom with inserts mimicking normal lung tissue and lung lesion was filled with [ 18 F]FDG. The lung lesion insert was driven by six different patient-specific respiratory patterns or kept stationary. PET/CT images were acquired under motionless ground truth, tidal breathing motion-averaged (3D), and respiratory phase-correlated (4D) conditions. Target volumes were estimated by standardized uptake value (SUV) thresholds that accurately defined the ground-truth lesion volume. Non-uniform dose-painting plans using volumetrically modulated arc therapy were optimized for fixed normal lung and spinal cord objectives and variable PET-based target objectives. Resulting plans were delivered to a cylindrical diode array at rest, in motion on a platform driven by the same respiratory patterns (3D), or motion-compensated by a robotic couch with an infrared camera tracking system (4D). Errors were estimated relative to the static ground truth condition for mean target-to-background (T/B mean ) ratios, target volumes, planned equivalent uniform target doses, and 2%-2 mm gamma delivery passing rates. Relative to motionless ground truth conditions, PET/CT imaging errors were on the order of 10–20%, treatment planning errors were 5–10%, and treatment delivery errors were 5–30% without motion compensation. Errors from residual motion following compensation methods were reduced to 5–10% in PET/CT imaging, <5% in treatment planning, and <2% in treatment delivery. We have demonstrated that estimation of respiratory motion uncertainty and its propagation from PET/CT imaging to RT

  20. Imaging and dosimetric errors in 4D PET/CT-guided radiotherapy from patient-specific respiratory patterns: a dynamic motion phantom end-to-end study

    Science.gov (United States)

    Bowen, S R; Nyflot, M J; Hermann, C; Groh, C; Meyer, J; Wollenweber, S D; Stearns, C W; Kinahan, P E; Sandison, G A

    2015-01-01

    Effective positron emission tomography/computed tomography (PET/CT) guidance in radiotherapy of lung cancer requires estimation and mitigation of errors due to respiratory motion. An end-to-end workflow was developed to measure patient-specific motion-induced uncertainties in imaging, treatment planning, and radiation delivery with respiratory motion phantoms and dosimeters. A custom torso phantom with inserts mimicking normal lung tissue and lung lesion was filled with [18F]FDG. The lung lesion insert was driven by 6 different patient-specific respiratory patterns or kept stationary. PET/CT images were acquired under motionless ground truth, tidal breathing motion-averaged (3D), and respiratory phase-correlated (4D) conditions. Target volumes were estimated by standardized uptake value (SUV) thresholds that accurately defined the ground-truth lesion volume. Non-uniform dose-painting plans using volumetrically modulated arc therapy (VMAT) were optimized for fixed normal lung and spinal cord objectives and variable PET-based target objectives. Resulting plans were delivered to a cylindrical diode array at rest, in motion on a platform driven by the same respiratory patterns (3D), or motion-compensated by a robotic couch with an infrared camera tracking system (4D). Errors were estimated relative to the static ground truth condition for mean target-to-background (T/Bmean) ratios, target volumes, planned equivalent uniform target doses (EUD), and 2%-2mm gamma delivery passing rates. Relative to motionless ground truth conditions, PET/CT imaging errors were on the order of 10–20%, treatment planning errors were 5–10%, and treatment delivery errors were 5–30% without motion compensation. Errors from residual motion following compensation methods were reduced to 5–10% in PET/CT imaging, PET/CT imaging to RT planning, and RT delivery under a dose painting paradigm is feasible within an integrated respiratory motion phantom workflow. For a limited set of cases, the

  1. N-acetylated metabolites in urine: proton nuclear magnetic resonance spectroscopic study on patients with inborn errors of metabolism.

    NARCIS (Netherlands)

    Engelke, U.F.H.; Liebrand-van Sambeek, M.L.F.; Jong, J.G.N. de; Leroy, J.G.; Morava, E.; Smeitink, J.A.M.; Wevers, R.A.

    2004-01-01

    BACKGROUND: There is no comprehensive analytical technique to analyze N-acetylated metabolites in urine. Many of these compounds are involved in inborn errors of metabolism. In the present study, we examined the potential of proton nuclear magnetic resonance ((1)H-NMR) spectroscopy as a tool to

  2. Social aspects of clinical errors.

    Science.gov (United States)

    Richman, Joel; Mason, Tom; Mason-Whitehead, Elizabeth; McIntosh, Annette; Mercer, Dave

    2009-08-01

    Clinical errors, whether committed by doctors, nurses or other professions allied to healthcare, remain a sensitive issue requiring open debate and policy formulation in order to reduce them. The literature suggests that the issues underpinning errors made by healthcare professionals involve concerns about patient safety, professional disclosure, apology, litigation, compensation, processes of recording and policy development to enhance quality service. Anecdotally, we are aware of narratives of minor errors, which may well have been covered up and remain officially undisclosed whilst the major errors resulting in damage and death to patients alarm both professionals and public with resultant litigation and compensation. This paper attempts to unravel some of these issues by highlighting the historical nature of clinical errors and drawing parallels to contemporary times by outlining the 'compensation culture'. We then provide an overview of what constitutes a clinical error and review the healthcare professional strategies for managing such errors.

  3. Labview Based ECG Patient Monitoring System for Cardiovascular Patient Using SMTP Technology

    OpenAIRE

    Singh, Om Prakash; Mekonnen, Dawit; Malarvili, M. B.

    2015-01-01

    This paper leads to developing a Labview based ECG patient monitoring system for cardiovascular patient using Simple Mail Transfer Protocol technology. The designed device has been divided into three parts. First part is ECG amplifier circuit, built using instrumentation amplifier (AD620) followed by signal conditioning circuit with the operation amplifier (lm741). Secondly, the DAQ card is used to convert the analog signal into digital form for the further process. Furthermore, the data has ...

  4. Errors in abdominal computed tomography

    International Nuclear Information System (INIS)

    Stephens, S.; Marting, I.; Dixon, A.K.

    1989-01-01

    Sixty-nine patients are presented in whom a substantial error was made on the initial abdominal computed tomography report. Certain features of these errors have been analysed. In 30 (43.5%) a lesion was simply not recognised (error of observation); in 39 (56.5%) the wrong conclusions were drawn about the nature of normal or abnormal structures (error of interpretation). The 39 errors of interpretation were more complex; in 7 patients an abnormal structure was noted but interpreted as normal, whereas in four a normal structure was thought to represent a lesion. Other interpretive errors included those where the wrong cause for a lesion had been ascribed (24 patients), and those where the abnormality was substantially under-reported (4 patients). Various features of these errors are presented and discussed. Errors were made just as often in relation to small and large lesions. Consultants made as many errors as senior registrar radiologists. It is like that dual reporting is the best method of avoiding such errors and, indeed, this is widely practised in our unit. (Author). 9 refs.; 5 figs.; 1 tab

  5. Quality Indicators in Laboratory Medicine: from theory to practice. Preliminary data from the IFCC Working Group Project "Laboratory Errors and Patient Safety".

    Science.gov (United States)

    Sciacovelli, Laura; O'Kane, Maurice; Skaik, Younis Abdelwahab; Caciagli, Patrizio; Pellegrini, Cristina; Da Rin, Giorgio; Ivanov, Agnes; Ghys, Timothy; Plebani, Mario

    2011-05-01

    The adoption of Quality Indicators (QIs) has prompted the development of tools to measure and evaluate the quality and effectiveness of laboratory testing, first in the hospital setting and subsequently in ambulatory and other care settings. While Laboratory Medicine has an important role in the delivery of high-quality care, no consensus exists as yet on the use of QIs focussing on all steps of the laboratory total testing process (TTP), and further research in this area is required. In order to reduce errors in laboratory testing, the IFCC Working Group on "Laboratory Errors and Patient Safety" (WG-LEPS) developed a series of Quality Indicators, specifically designed for clinical laboratories. In the first phase of the project, specific QIs for key processes of the TTP were identified, including all the pre-, intra- and post-analytic steps. The overall aim of the project is to create a common reporting system for clinical laboratories based on standardized data collection, and to define state-of-the-art and Quality Specifications (QSs) for each QI independent of: a) the size of organization and type of activities; b) the complexity of processes undertaken; and c) different degree of knowledge and ability of the staff. The aim of the present paper is to report the results collected from participating laboratories from February 2008 to December 2009 and to identify preliminary QSs. The results demonstrate that a Model of Quality Indicators managed as an External Quality Assurance Program can serve as a tool to monitor and control the pre-, intra- and post-analytical activities. It might also allow clinical laboratories to identify risks that lead to errors resulting in patient harm: identification and design of practices that eliminate medical errors; the sharing of information and education of clinical and laboratory teams on practices that reduce or prevent errors; the monitoring and evaluation of improvement activities.

  6. Patient educational technologies and their use by patients diagnosed with localized prostate cancer.

    Science.gov (United States)

    Baverstock, Richard J; Crump, R Trafford; Carlson, Kevin V

    2015-09-29

    Two urology practices in Calgary, Canada use patient educational technology (PET) as a core component of their clinical practice. The purpose of this study was to determine how patients interact with PET designed to inform them about their treatment options for clinically localized prostate cancer. A PET library was developed with 15 unique prostate-related educational modules relating to diagnosis, treatment options, and potential side effects. The PET collected data regarding its use, and those data were used to conduct a retrospective analysis. Descriptive analyses were conducted and comparisons made between patients' utilization of the PET library during first and subsequent access; Pearson's Chi-Square was used to test for statistical significance, where appropriate. Every patient (n = 394) diagnosed with localized prostate cancer was given access to the PET library using a unique identifier. Of those, 123 logged into the library and viewed at least one module and 94 patients logged into the library more than once. The average patient initially viewed modules pertaining to their diagnosis. Viewing behavior significantly changed in subsequent logins, moving towards modules pertaining to treatment options, decision making, and post-surgical information. As observed through the longitudinal utilization of the PET library, information technology offers clinicians an opportunity to provide an interactive platform to meet patients' dynamic educational needs. Understanding these needs will help inform the development of more useful PETs. The informational needs of patients diagnosed with clinically localized prostate cancer changed throughout the course of their diagnosis and treatment.

  7. Leveraging information technology to drive improvement in patient satisfaction.

    Science.gov (United States)

    Nash, Mary; Pestrue, Justin; Geier, Peter; Sharp, Karen; Helder, Amy; McAlearney, Ann Scheck

    2010-01-01

    A healthcare organization's commitment to quality and the patient experience requires senior leader involvement in improvement strategies, and accountability for goals. Further, improvement strategies are most effective when driven by data, and in the world of patient satisfaction, evidence is growing that nurse leader rounding and discharge calls are strategic tactics that can improve patient satisfaction. This article describes how The Ohio State University Medical Center (OSUMC) leveraged health information technology (IT) to apply a data-driven strategy execution to improve the patient experience. Specifically, two IT-driven approaches were used: (1) business intelligence reporting tools were used to create a meaningful reporting system including dashboards, scorecards, and tracking reports and (2) an improvement plan was implemented that focused on two high-impact tactics and data to hardwire accountability. Targeted information from the IT systems enabled clinicians and administrators to execute these strategic tactics, and senior leaders to monitor achievement of strategic goals. As a result, OSUMC's inpatient satisfaction scores on the Hospital Consumer Assessment of Healthcare Providers and Systems survey improved from 56% nines and tens in 2006 to 71% in 2009. © 2010 National Association for Healthcare Quality.

  8. Through Patients' Eyes: Regulation, Technology, Privacy, and the Future.

    Science.gov (United States)

    Petersen, Carolyn

    2018-04-22

    Privacy is commonly regarded as a regulatory requirement achieved via technical and organizational management practices. Those working in the field of informatics often play a role in privacy preservation as a result of their expertise in information technology, workflow analysis, implementation science, or related skills. Viewing privacy from the perspective of patients whose protected health information is at risk broadens the considerations to include the perceived duality of privacy; the existence of privacy within a context unique to each patient; the competing needs inherent within privacy management; the need for particular consideration when data are shared; and the need for patients to control health information in a global setting. With precision medicine, artificial intelligence, and other treatment innovations on the horizon, health care professionals need to think more broadly about how to preserve privacy in a health care environment driven by data sharing. Patient-reported privacy preferences, privacy portability, and greater transparency around privacy-preserving functionalities are potential strategies for ensuring that privacy regulations are met and privacy is preserved. Georg Thieme Verlag KG Stuttgart.

  9. Medication Errors - A Review

    OpenAIRE

    Vinay BC; Nikhitha MK; Patel Sunil B

    2015-01-01

    In this present review article, regarding medication errors its definition, medication error problem, types of medication errors, common causes of medication errors, monitoring medication errors, consequences of medication errors, prevention of medication error and managing medication errors have been explained neatly and legibly with proper tables which is easy to understand.

  10. SU-E-T-261: Development of An Automated System to Detect Patient Identification and Positioning Errors Prior to Radiotherapy Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Jani, S; Low, D; Lamb, J [UCLA, Los Angeles, CA (United States)

    2015-06-15

    Purpose: To develop a system that can automatically detect patient identification and positioning errors using 3D computed tomography (CT) setup images and kilovoltage CT (kVCT) planning images. Methods: Planning kVCT images were collected for head-and-neck (H&N), pelvis, and spine treatments with corresponding 3D cone-beam CT (CBCT) and megavoltage CT (MVCT) setup images from TrueBeam and TomoTherapy units, respectively. Patient identification errors were simulated by registering setup and planning images from different patients. Positioning errors were simulated by misaligning the setup image by 1cm to 5cm in the six anatomical directions for H&N and pelvis patients. Misalignments for spine treatments were simulated by registering the setup image to adjacent vertebral bodies on the planning kVCT. A body contour of the setup image was used as an initial mask for image comparison. Images were pre-processed by image filtering and air voxel thresholding, and image pairs were assessed using commonly-used image similarity metrics as well as custom -designed metrics. A linear discriminant analysis classifier was trained and tested on the datasets, and misclassification error (MCE), sensitivity, and specificity estimates were generated using 10-fold cross validation. Results: Our workflow produced MCE estimates of 0.7%, 1.7%, and 0% for H&N, pelvis, and spine TomoTherapy images, respectively. Sensitivities and specificities ranged from 98.0% to 100%. MCEs of 3.5%, 2.3%, and 2.1% were obtained for TrueBeam images of the above sites, respectively, with sensitivity and specificity estimates between 96.2% and 98.4%. MCEs for 1cm H&N/pelvis misalignments were 1.3/5.1% and 9.1/8.6% for TomoTherapy and TrueBeam images, respectively. 2cm MCE estimates were 0.4%/1.6% and 3.1/3.2%, respectively. Vertebral misalignment MCEs were 4.8% and 4.9% for TomoTherapy and TrueBeam images, respectively. Conclusion: Patient identification and gross misalignment errors can be robustly and

  11. SU-E-T-261: Development of An Automated System to Detect Patient Identification and Positioning Errors Prior to Radiotherapy Treatment

    International Nuclear Information System (INIS)

    Jani, S; Low, D; Lamb, J

    2015-01-01

    Purpose: To develop a system that can automatically detect patient identification and positioning errors using 3D computed tomography (CT) setup images and kilovoltage CT (kVCT) planning images. Methods: Planning kVCT images were collected for head-and-neck (H&N), pelvis, and spine treatments with corresponding 3D cone-beam CT (CBCT) and megavoltage CT (MVCT) setup images from TrueBeam and TomoTherapy units, respectively. Patient identification errors were simulated by registering setup and planning images from different patients. Positioning errors were simulated by misaligning the setup image by 1cm to 5cm in the six anatomical directions for H&N and pelvis patients. Misalignments for spine treatments were simulated by registering the setup image to adjacent vertebral bodies on the planning kVCT. A body contour of the setup image was used as an initial mask for image comparison. Images were pre-processed by image filtering and air voxel thresholding, and image pairs were assessed using commonly-used image similarity metrics as well as custom -designed metrics. A linear discriminant analysis classifier was trained and tested on the datasets, and misclassification error (MCE), sensitivity, and specificity estimates were generated using 10-fold cross validation. Results: Our workflow produced MCE estimates of 0.7%, 1.7%, and 0% for H&N, pelvis, and spine TomoTherapy images, respectively. Sensitivities and specificities ranged from 98.0% to 100%. MCEs of 3.5%, 2.3%, and 2.1% were obtained for TrueBeam images of the above sites, respectively, with sensitivity and specificity estimates between 96.2% and 98.4%. MCEs for 1cm H&N/pelvis misalignments were 1.3/5.1% and 9.1/8.6% for TomoTherapy and TrueBeam images, respectively. 2cm MCE estimates were 0.4%/1.6% and 3.1/3.2%, respectively. Vertebral misalignment MCEs were 4.8% and 4.9% for TomoTherapy and TrueBeam images, respectively. Conclusion: Patient identification and gross misalignment errors can be robustly and

  12. Effects of Patient Care Unit Design and Technology on Nurse and Patient Care Technician Communication.

    Science.gov (United States)

    Beck, Mary S; Doscher, Mindy

    2018-04-01

    The current study described RN and patient care technician (PCT) communication in centralized and hybrid decentralized workstation designs using hands-free communication technology and infrared locator badge technology to facilitate communication. New construction of an oncology unit provided the opportunity to compare staff communication in two different workstation designs. Observations and questionnaires compared nurse and PCT communication in the two-unit designs. Descriptive statistics were used to analyze the differences. The hybrid decentralized unit had increased use of hands-free communication technology and hallway communication by nurses and PCTs, and increased patient room communication by nurses. Perceptions of communication between nurses and PCTs and congruency of priorities for care were similar for both units. The locator badge technology had limited adoption. Replacement of nurse workstations with new construction or remodeling impact staff communication patterns, necessitating that nurse leaders understand the impact of design and technology on communication. [Journal of Gerontological Nursing, 44(4), 17-22.]. Copyright 2018, SLACK Incorporated.

  13. Technology-based assessment in patients with disorders of consciousness

    Directory of Open Access Journals (Sweden)

    Carol Di Perri

    2014-09-01

    Full Text Available Introduction. A number of studies highlight the difficulty in forming a diagnosis for patients with disorders of consciousness when this is established merely on behavioral assessments. Background. Positron emission tomography (PET, functional magnetic resonance imaging (fMRI, diffusion tensor imaging (DTI, and electroencephalography combined with transcranial magnetic stimulation (TMS-EEG techniques are promoting the clinical characterization of this challenging population. With such technology-based "objective" tools, patients are also differentially able to follow simple commands and in some cases even communicate through modified brain activity. Consequently, the vegetative state and minimally conscious state have been revised and new nosologies have been proposed, namely the unresponsive wakefulness syndrome, the minimally conscious state plus and minus, and the functional locked-in syndrome. Aim. To our mind, an integration of different technical modalities is important to gain a holistic vision of the underlying pathophysiology of disorders of consciousness in general and to promote single-patient medical management in particular.

  14. Using Digital Technology to Engage and Communicate with Patients: A Survey of Patient Attitudes.

    Science.gov (United States)

    Jenssen, Brian P; Mitra, Nandita; Shah, Anand; Wan, Fei; Grande, David

    2016-01-01

    As primary care moves toward a system of population health management, providers will need to engage patients outside traditional office-based interactions. We assessed patient attitudes regarding technology use to communicate with their primary care team or to engage with other patients outside typical office settings. Design/Participants/Main Measures We conducted a national survey using GfK KnowledgePanel(®) to examine attitudes on the use of digital technology (email, text messaging, and social media such as Facebook and Twitter) to communicate with primary care teams about health behavior goals and test results. We also assessed attitudes toward the use of digital technologies to engage with other patients in activities such as peer coaching. Of the 5119 panel members invited to participate, 3336 completed the survey (response rate, 65.2 %). Among respondents, more than half (58 %) reported using Facebook, and nearly two-thirds (64.1 %) used text messaging. Overall, few participants were willing to communicate about health goals via social media (3.1 %) or text messaging (13.3 %), compared to email (48.8 %) or phone (75.5 %) (results were similar for communication about test results). Among those that used text messaging, race/ethnicity was the only factor independently associated with greater support for text messaging [African American (OR 1.44; 95 % CI, 1.01-2.06) and Hispanic (OR 1.8; 95 % CI, 1.25-2.59)] in multivariate models. Participants interested in engaging in peer coaching through Facebook (11.7 %) were more likely to be younger (p digital technology such as text messaging and social media, few participants supported using these tools for communicating with their physicians' practice. Participants were most supportive of using email for communication. Contrary to previous studies, among users of technology, low socioeconomic status and racial/ethnic minorities were equally or more likely to support use.

  15. Why are autopsy rates low in Japan? Views of ordinary citizens and doctors in the case of unexpected patient death and medical error.

    Science.gov (United States)

    Maeda, Shoichi; Kamishiraki, Etsuko; Starkey, Jay; Ikeda, Noriaki

    2013-01-01

    This article examines what could account for the low autopsy rate in Japan based on the findings from an anonymous, self-administered, structured questionnaire that was given to a sample population of the general public and physicians in Japan. The general public and physicians indicated that autopsy may not be carried out because: (1) conducting an autopsy might result in the accusation that patient death was caused by a medical error even when there was no error (50.4% vs. 13.1%, respectively), (2) suggesting an autopsy makes the families suspicious of a medical error even when there was none (61.0% vs. 19.1%, respectively), (3) families do not want the body to be damaged by autopsy (81.6% vs. 87.3%, respectively), and (4) families do not want to make the patient suffer any more in addition to what he/she has already endured (61.8% vs. 87.1%, respectively). © 2013 American Society for Healthcare Risk Management of the American Hospital Association.

  16. Error Budgeting

    Energy Technology Data Exchange (ETDEWEB)

    Vinyard, Natalia Sergeevna [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Perry, Theodore Sonne [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Usov, Igor Olegovich [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-10-04

    We calculate opacity from k (hn)=-ln[T(hv)]/pL, where T(hv) is the transmission for photon energy hv, p is sample density, and L is path length through the sample. The density and path length are measured together by Rutherford backscatter. Δk = $\\partial k$\\ $\\partial T$ ΔT + $\\partial k$\\ $\\partial (pL)$. We can re-write this in terms of fractional error as Δk/k = Δ1n(T)/T + Δ(pL)/(pL). Transmission itself is calculated from T=(U-E)/(V-E)=B/B0, where B is transmitted backlighter (BL) signal and B0 is unattenuated backlighter signal. Then ΔT/T=Δln(T)=ΔB/B+ΔB0/B0, and consequently Δk/k = 1/T (ΔB/B + ΔB$_0$/B$_0$ + Δ(pL)/(pL). Transmission is measured in the range of 0.2

  17. The preliminary development and testing of a global trigger tool to detect error and patient harm in primary-care records.

    Science.gov (United States)

    de Wet, C; Bowie, P

    2009-04-01

    A multi-method strategy has been proposed to understand and improve the safety of primary care. The trigger tool is a relatively new method that has shown promise in American and secondary healthcare settings. It involves the focused review of a random sample of patient records using a series of "triggers" that alert reviewers to potential errors and previously undetected adverse events. To develop and test a global trigger tool to detect errors and adverse events in primary-care records. Trigger tool development was informed by previous research and content validated by expert opinion. The tool was applied by trained reviewers who worked in pairs to conduct focused audits of 100 randomly selected electronic patient records in each of five urban general practices in central Scotland. Review of 500 records revealed 2251 consultations and 730 triggers. An adverse event was found in 47 records (9.4%), indicating that harm occurred at a rate of one event per 48 consultations. Of these, 27 were judged to be preventable (42%). A further 17 records (3.4%) contained evidence of a potential adverse event. Harm severity was low to moderate for most patients (82.9%). Error and harm rates were higher in those aged > or =60 years, and most were medication-related (59%). The trigger tool was successful in identifying undetected patient harm in primary-care records and may be the most reliable method for achieving this. However, the feasibility of its routine application is open to question. The tool may have greater utility as a research rather than an audit technique. Further testing in larger, representative study samples is required.

  18. Errors in Neonatology

    Directory of Open Access Journals (Sweden)

    Antonio Boldrini

    2013-06-01

    Full Text Available Introduction: Danger and errors are inherent in human activities. In medical practice errors can lean to adverse events for patients. Mass media echo the whole scenario. Methods: We reviewed recent published papers in PubMed database to focus on the evidence and management of errors in medical practice in general and in Neonatology in particular. We compared the results of the literature with our specific experience in Nina Simulation Centre (Pisa, Italy. Results: In Neonatology the main error domains are: medication and total parenteral nutrition, resuscitation and respiratory care, invasive procedures, nosocomial infections, patient identification, diagnostics. Risk factors include patients’ size, prematurity, vulnerability and underlying disease conditions but also multidisciplinary teams, working conditions providing fatigue, a large variety of treatment and investigative modalities needed. Discussion and Conclusions: In our opinion, it is hardly possible to change the human beings but it is likely possible to change the conditions under they work. Voluntary errors report systems can help in preventing adverse events. Education and re-training by means of simulation can be an effective strategy too. In Pisa (Italy Nina (ceNtro di FormazIone e SimulazioNe NeonAtale is a simulation center that offers the possibility of a continuous retraining for technical and non-technical skills to optimize neonatological care strategies. Furthermore, we have been working on a novel skill trainer for mechanical ventilation (MEchatronic REspiratory System SImulator for Neonatal Applications, MERESSINA. Finally, in our opinion national health policy indirectly influences risk for errors. Proceedings of the 9th International Workshop on Neonatology · Cagliari (Italy · October 23rd-26th, 2013 · Learned lessons, changing practice and cutting-edge research

  19. Characterization of Patient Interest in Provider-Based Consumer Health Information Technology: Survey Study.

    Science.gov (United States)

    Featherall, Joseph; Lapin, Brittany; Chaitoff, Alexander; Havele, Sonia A; Thompson, Nicolas; Katzan, Irene

    2018-04-19

    Consumer health information technology can improve patient engagement in their health care and assist in navigating the complexities of health care delivery. However, the consumer health information technology offerings of health systems are often driven by provider rather than patient perspectives and inadequately address patient needs, thus limiting their adoption by patients. Consideration given to patients as stakeholders in the development of such technologies may improve adoption, efficacy, and consumer health information technology resource allocation. The aims of this paper were to measure patient interest in different health system consumer health information technology apps and determine the influence of patient characteristics on consumer health information technology interest. Patients seen at the Cleveland Clinic Neurological Institute were electronically surveyed on their interest in using different consumer health information technology apps. A self-efficacy scale, Patient Health Questionnaire-9 depression screen, and EuroQol 5 dimensions health-related quality of life scale were also completed by patients. Logistic regression was used to determine the influence of patient characteristics on interest in consumer health information technology in the categories of self-management, education, and communication. The majority of 3852 patient respondents had an interest in all technology categories assessed in the survey. The highest interest was in apps that allow patients to ask questions of providers (3476/3852, 90.24%) and to schedule appointments (3211/3839, 83.64%). Patient interest in consumer health information technology was significantly associated with greater depression symptoms, worse quality of life, greater health self-efficacy, and smartphone ownership (Pinformation technology development and their perspectives should consistently guide development efforts. Health systems should consider focusing on consumer health information technologies

  20. Measuring and improving patient safety through health information technology: The Health IT Safety Framework.

    Science.gov (United States)

    Singh, Hardeep; Sittig, Dean F

    2016-04-01

    Health information technology (health IT) has potential to improve patient safety but its implementation and use has led to unintended consequences and new safety concerns. A key challenge to improving safety in health IT-enabled healthcare systems is to develop valid, feasible strategies to measure safety concerns at the intersection of health IT and patient safety. In response to the fundamental conceptual and methodological gaps related to both defining and measuring health IT-related patient safety, we propose a new framework, the Health IT Safety (HITS) measurement framework, to provide a conceptual foundation for health IT-related patient safety measurement, monitoring, and improvement. The HITS framework follows both Continuous Quality Improvement (CQI) and sociotechnical approaches and calls for new measures and measurement activities to address safety concerns in three related domains: 1) concerns that are unique and specific to technology (e.g., to address unsafe health IT related to unavailable or malfunctioning hardware or software); 2) concerns created by the failure to use health IT appropriately or by misuse of health IT (e.g. to reduce nuisance alerts in the electronic health record (EHR)), and 3) the use of health IT to monitor risks, health care processes and outcomes and identify potential safety concerns before they can harm patients (e.g. use EHR-based algorithms to identify patients at risk for medication errors or care delays). The framework proposes to integrate both retrospective and prospective measurement of HIT safety with an organization's existing clinical risk management and safety programs. It aims to facilitate organizational learning, comprehensive 360 degree assessment of HIT safety that includes vendor involvement, refinement of measurement tools and strategies, and shared responsibility to identify problems and implement solutions. A long term framework goal is to enable rigorous measurement that helps achieve the safety

  1. Controlling errors in unidosis carts

    Directory of Open Access Journals (Sweden)

    Inmaculada Díaz Fernández

    2010-01-01

    Full Text Available Objective: To identify errors in the unidosis system carts. Method: For two months, the Pharmacy Service controlled medication either returned or missing from the unidosis carts both in the pharmacy and in the wards. Results: Uncorrected unidosis carts show a 0.9% of medication errors (264 versus 0.6% (154 which appeared in unidosis carts previously revised. In carts not revised, the error is 70.83% and mainly caused when setting up unidosis carts. The rest are due to a lack of stock or unavailability (21.6%, errors in the transcription of medical orders (6.81% or that the boxes had not been emptied previously (0.76%. The errors found in the units correspond to errors in the transcription of the treatment (3.46%, non-receipt of the unidosis copy (23.14%, the patient did not take the medication (14.36%or was discharged without medication (12.77%, was not provided by nurses (14.09%, was withdrawn from the stocks of the unit (14.62%, and errors of the pharmacy service (17.56% . Conclusions: It is concluded the need to redress unidosis carts and a computerized prescription system to avoid errors in transcription.Discussion: A high percentage of medication errors is caused by human error. If unidosis carts are overlooked before sent to hospitalization units, the error diminishes to 0.3%.

  2. Blood specimen labelling errors: Implications for nephrology nursing practice.

    Science.gov (United States)

    Duteau, Jennifer

    2014-01-01

    Patient safety is the foundation of high-quality health care, as recognized both nationally and worldwide. Patient blood specimen identification is critical in ensuring the delivery of safe and appropriate care. The practice of nephrology nursing involves frequent patient blood specimen withdrawals to treat and monitor kidney disease. A critical review of the literature reveals that incorrect patient identification is one of the major causes of blood specimen labelling errors. Misidentified samples create a serious risk to patient safety leading to multiple specimen withdrawals, delay in diagnosis, misdiagnosis, incorrect treatment, transfusion reactions, increased length of stay and other negative patient outcomes. Barcode technology has been identified as a preferred method for positive patient identification leading to a definitive decrease in blood specimen labelling errors by as much as 83% (Askeland, et al., 2008). The use of a root cause analysis followed by an action plan is one approach to decreasing the occurrence of blood specimen labelling errors. This article will present a review of the evidence-based literature surrounding blood specimen labelling errors, followed by author recommendations for completing a root cause analysis and action plan. A failure modes and effects analysis (FMEA) will be presented as one method to determine root cause, followed by the Ottawa Model of Research Use (OMRU) as a framework for implementation of strategies to reduce blood specimen labelling errors.

  3. Ethical evaluation model for technologies. the role of medical technology in the development of autonomy in diabetes patient.

    Science.gov (United States)

    Damian, Simona; Necula, Roxana; Sandu, A; Iliescu, Maria Liliana; Ioan, Beatrice

    2013-01-01

    Romanian Government Decision (GD) No. 8/2012 amending and supplementing GD No. 144/2010 regarding the function and organization structures of the Ministry of Health defines health technology assessment (HTA) as "a systematic and multidisciplinary analysis of the existing and new medical technologies, through which medical, economic, social, ethical and organizational information are synthesized so that medical technologies to be used in a transparent and unbiased manner". We propose an ethical assessment model of technologies used in the care of diabetic patients. The nature of this research was exploratory, giving the novelty of this approach to the clinical and social context of Romania. The assessment of health technologies used in the care of diabetic patients was based on the following research question: What is the role of health technology in developing autonomy and responsibility in patients suffering from chronic diseases? Individual interviews and focus groups were held from June, 2011 to November, 2012 in Iasi. The criterion for selecting the participants was belonging to the target groups: family doctors or diabetes specialist, patients with type 1 (TID) and type 2 diabetes (T2D), caregivers and other professionals involved in diabetes patient care. The diabetic patient benefits from a specific treatment and has the privilege of self-administering it, his life expectancy and quality of life depending upon the compliance and responsibility he demonstrates.

  4. Errors in clinical laboratories or errors in laboratory medicine?

    Science.gov (United States)

    Plebani, Mario

    2006-01-01

    Laboratory testing is a highly complex process and, although laboratory services are relatively safe, they are not as safe as they could or should be. Clinical laboratories have long focused their attention on quality control methods and quality assessment programs dealing with analytical aspects of testing. However, a growing body of evidence accumulated in recent decades demonstrates that quality in clinical laboratories cannot be assured by merely focusing on purely analytical aspects. The more recent surveys on errors in laboratory medicine conclude that in the delivery of laboratory testing, mistakes occur more frequently before (pre-analytical) and after (post-analytical) the test has been performed. Most errors are due to pre-analytical factors (46-68.2% of total errors), while a high error rate (18.5-47% of total errors) has also been found in the post-analytical phase. Errors due to analytical problems have been significantly reduced over time, but there is evidence that, particularly for immunoassays, interference may have a serious impact on patients. A description of the most frequent and risky pre-, intra- and post-analytical errors and advice on practical steps for measuring and reducing the risk of errors is therefore given in the present paper. Many mistakes in the Total Testing Process are called "laboratory errors", although these may be due to poor communication, action taken by others involved in the testing process (e.g., physicians, nurses and phlebotomists), or poorly designed processes, all of which are beyond the laboratory's control. Likewise, there is evidence that laboratory information is only partially utilized. A recent document from the International Organization for Standardization (ISO) recommends a new, broader definition of the term "laboratory error" and a classification of errors according to different criteria. In a modern approach to total quality, centered on patients' needs and satisfaction, the risk of errors and mistakes

  5. Correction of refractive errors

    Directory of Open Access Journals (Sweden)

    Vladimir Pfeifer

    2005-10-01

    Full Text Available Background: Spectacles and contact lenses are the most frequently used, the safest and the cheapest way to correct refractive errors. The development of keratorefractive surgery has brought new opportunities for correction of refractive errors in patients who have the need to be less dependent of spectacles or contact lenses. Until recently, RK was the most commonly performed refractive procedure for nearsighted patients.Conclusions: The introduction of excimer laser in refractive surgery has given the new opportunities of remodelling the cornea. The laser energy can be delivered on the stromal surface like in PRK or deeper on the corneal stroma by means of lamellar surgery. In LASIK flap is created with microkeratome in LASEK with ethanol and in epi-LASIK the ultra thin flap is created mechanically.

  6. Adjusting for the Incidence of Measurement Errors in Multilevel ...

    African Journals Online (AJOL)

    the incidence of measurement errors using these techniques generally revealed coefficient estimates of ... physical, biological, social and medical science, measurement errors are found. The errors are ... (M) and Science and Technology (ST).

  7. Translational and rotational intra- and inter-fractional errors in patient and target position during a short course of frameless stereotactic body radiotherapy

    International Nuclear Information System (INIS)

    Josipovic, Mirjana; Fredberg Persson, Gitte; Logadottir, Aashildur; Smulders, Bob; Westmann, Gunnar; Bangsgaard, Jens Peter

    2012-01-01

    Background. Implementation of cone beam computed tomography (CBCT) in frameless stereotactic body radiotherapy (SBRT) of lung tumours enables setup correction based on tumour position. The aim of this study was to compare setup accuracy with daily soft tissue matching to bony anatomy matching and evaluate intra- and inter-fractional translational and rotational errors in patient and target positions. Material and methods. Fifteen consecutive SBRT patients were included in the study. Vacuum cushions were used for immobilisation. SBRT plans were based on midventilation phase of four-dimensional (4D)-CT or three-dimensional (3D)-CT from PET/CT. Margins of 5 mm in the transversal plane and 10 mm in the cranio-caudal (CC) direction were applied. SBRT was delivered in three fractions within a week. At each fraction, CBCT was performed before and after the treatment. Setup accuracy comparison between soft tissue matching and bony anatomy matching was evaluated on pretreatment CBCTs. From differences in pre- and post-treatment CBCTs, we evaluated the extent of translational and rotational intra-fractional changes in patient position, tumour position and tumour baseline shift. All image registration was rigid with six degrees of freedom. Results. The median 3D difference between patient position based on bony anatomy matching and soft tissue matching was 3.0 mm (0-8.3 mm). The median 3D intra-fractional change in patient position was 1.4 mm (0-12.2 mm) and 2.2 mm (0-13.2 mm) in tumour position. The median 3D intra-fractional baseline shift was 2.2 mm (0-4.7 mm). With correction of translational errors, the remaining systematic and random errors were approximately 1deg. Conclusion. Soft tissue tumour matching improved precision of treatment delivery in frameless SBRT of lung tumours compared to image guidance using bone matching. The intra-fractional displacement of the target position was affected by both translational and rotational changes in tumour baseline position

  8. Heuristic errors in clinical reasoning.

    Science.gov (United States)

    Rylander, Melanie; Guerrasio, Jeannette

    2016-08-01

    Errors in clinical reasoning contribute to patient morbidity and mortality. The purpose of this study was to determine the types of heuristic errors made by third-year medical students and first-year residents. This study surveyed approximately 150 clinical educators inquiring about the types of heuristic errors they observed in third-year medical students and first-year residents. Anchoring and premature closure were the two most common errors observed amongst third-year medical students and first-year residents. There was no difference in the types of errors observed in the two groups. Errors in clinical reasoning contribute to patient morbidity and mortality Clinical educators perceived that both third-year medical students and first-year residents committed similar heuristic errors, implying that additional medical knowledge and clinical experience do not affect the types of heuristic errors made. Further work is needed to help identify methods that can be used to reduce heuristic errors early in a clinician's education. © 2015 John Wiley & Sons Ltd.

  9. Wireless technology infrastructures for authentication of patients: PKI that rings.

    Science.gov (United States)

    Sax, Ulrich; Kohane, Isaac; Mandl, Kenneth D

    2005-01-01

    As the public interest in consumer-driven electronic health care applications rises, so do concerns about the privacy and security of these applications. Achieving a balance between providing the necessary security while promoting user acceptance is a major obstacle in large-scale deployment of applications such as personal health records (PHRs). Robust and reliable forms of authentication are needed for PHRs, as the record will often contain sensitive and protected health information, including the patient's own annotations. Since the health care industry per se is unlikely to succeed at single-handedly developing and deploying a large scale, national authentication infrastructure, it makes sense to leverage existing hardware, software, and networks. This report proposes a new model for authentication of users to health care information applications, leveraging wireless mobile devices. Cell phones are widely distributed, have high user acceptance, and offer advanced security protocols. The authors propose harnessing this technology for the strong authentication of individuals by creating a registration authority and an authentication service, and examine the problems and promise of such a system.

  10. [Technological advances and micro-inflammation in dialysis patients].

    Science.gov (United States)

    Ferro, Giuseppe; Ravaglia, Fiammetta; Ferrari, Elisa; Romoli, Elena; Michelassi, Stefano; Caiani, David; Pizzarelli, Francesco

    2015-01-01

    As currently performed, on line hemodiafiltration reduces, but does not normalize, the micro-inflammation of uremic patients. Recent technological advances make it possible to further reduce the inflammation connected to the dialysis treatment. 
Short bacterial DNA fragments are pro-inflammatory and can be detected in the dialysis fluids. However, their determination is not currently within normal controls of the quality of the dialysate. The scenario may change once the analysis of these fragments yields reliable, inexpensive, quick and easy to evaluate the results. At variance with standard bicarbonate dialysate, Citrate dialysate induces far less inflammation both for the well-known anti-inflammatory effect of such buffer and also because it is completely acetate free, e.g. a definitely pro-inflammatory buffer. However, the extensive use of citrate dialysate in chronic dialysis is prevented because of concerns about its potential calcium lowering effect. In our view, high convective exchange on line hemodiafiltration performed with dialysate, whose sterility and a-pirogenicity is guaranteed by increasingly sophisticated controls and with citrate buffer whose safety is certified, can serve as the gold standard of dialysis treatments in future.

  11. Errors on the Trail Making Test Are Associated with Right Hemispheric Frontal Lobe Damage in Stroke Patients

    Directory of Open Access Journals (Sweden)

    Bruno Kopp

    2015-01-01

    Full Text Available Measures of performance on the Trail Making Test (TMT are among the most popular neuropsychological assessment techniques. Completion time on TMT-A is considered to provide a measure of processing speed, whereas completion time on TMT-B is considered to constitute a behavioral measure of the ability to shift between cognitive sets (cognitive flexibility, commonly attributed to the frontal lobes. However, empirical evidence linking performance on the TMT-B to localized frontal lesions is mostly lacking. Here, we examined the association of frontal lesions following stroke with TMT-B performance measures (i.e., completion time and completion accuracy measures using voxel-based lesion-behavior mapping, with a focus on right hemispheric frontal lobe lesions. Our results suggest that the number of errors, but not completion time on the TMT-B, is associated with right hemispheric frontal lesions. This finding contradicts common clinical practice—the use of completion time on the TMT-B to measure cognitive flexibility, and it underscores the need for additional research on the association between cognitive flexibility and the frontal lobes. Further work in a larger sample, including left frontal lobe damage and with more power to detect effects of right posterior brain injury, is necessary to determine whether our observation is specific for right frontal lesions.

  12. Threat and error management for anesthesiologists: a predictive risk taxonomy

    Science.gov (United States)

    Ruskin, Keith J.; Stiegler, Marjorie P.; Park, Kellie; Guffey, Patrick; Kurup, Viji; Chidester, Thomas

    2015-01-01

    Purpose of review Patient care in the operating room is a dynamic interaction that requires cooperation among team members and reliance upon sophisticated technology. Most human factors research in medicine has been focused on analyzing errors and implementing system-wide changes to prevent them from recurring. We describe a set of techniques that has been used successfully by the aviation industry to analyze errors and adverse events and explain how these techniques can be applied to patient care. Recent findings Threat and error management (TEM) describes adverse events in terms of risks or challenges that are present in an operational environment (threats) and the actions of specific personnel that potentiate or exacerbate those threats (errors). TEM is a technique widely used in aviation, and can be adapted for the use in a medical setting to predict high-risk situations and prevent errors in the perioperative period. A threat taxonomy is a novel way of classifying and predicting the hazards that can occur in the operating room. TEM can be used to identify error-producing situations, analyze adverse events, and design training scenarios. Summary TEM offers a multifaceted strategy for identifying hazards, reducing errors, and training physicians. A threat taxonomy may improve analysis of critical events with subsequent development of specific interventions, and may also serve as a framework for training programs in risk mitigation. PMID:24113268

  13. Cognitive aspect of diagnostic errors.

    Science.gov (United States)

    Phua, Dong Haur; Tan, Nigel C K

    2013-01-01

    Diagnostic errors can result in tangible harm to patients. Despite our advances in medicine, the mental processes required to make a diagnosis exhibits shortcomings, causing diagnostic errors. Cognitive factors are found to be an important cause of diagnostic errors. With new understanding from psychology and social sciences, clinical medicine is now beginning to appreciate that our clinical reasoning can take the form of analytical reasoning or heuristics. Different factors like cognitive biases and affective influences can also impel unwary clinicians to make diagnostic errors. Various strategies have been proposed to reduce the effect of cognitive biases and affective influences when clinicians make diagnoses; however evidence for the efficacy of these methods is still sparse. This paper aims to introduce the reader to the cognitive aspect of diagnostic errors, in the hope that clinicians can use this knowledge to improve diagnostic accuracy and patient outcomes.

  14. Error correcting coding for OTN

    DEFF Research Database (Denmark)

    Justesen, Jørn; Larsen, Knud J.; Pedersen, Lars A.

    2010-01-01

    Forward error correction codes for 100 Gb/s optical transmission are currently receiving much attention from transport network operators and technology providers. We discuss the performance of hard decision decoding using product type codes that cover a single OTN frame or a small number...... of such frames. In particular we argue that a three-error correcting BCH is the best choice for the component code in such systems....

  15. E-Prescribing Errors in Community Pharmacies: Exploring Consequences and Contributing Factors

    Science.gov (United States)

    Stone, Jamie A.; Chui, Michelle A.

    2014-01-01

    Objective To explore types of e-prescribing errors in community pharmacies and their potential consequences, as well as the factors that contribute to e-prescribing errors. Methods Data collection involved performing 45 total hours of direct observations in five pharmacies. Follow-up interviews were conducted with 20 study participants. Transcripts from observations and interviews were subjected to content analysis using NVivo 10. Results Pharmacy staff detected 75 e-prescription errors during the 45 hour observation in pharmacies. The most common e-prescribing errors were wrong drug quantity, wrong dosing directions, wrong duration of therapy, and wrong dosage formulation. Participants estimated that 5 in 100 e-prescriptions have errors. Drug classes that were implicated in e-prescribing errors were antiinfectives, inhalers, ophthalmic, and topical agents. The potential consequences of e-prescribing errors included increased likelihood of the patient receiving incorrect drug therapy, poor disease management for patients, additional work for pharmacy personnel, increased cost for pharmacies and patients, and frustrations for patients and pharmacy staff. Factors that contribute to errors included: technology incompatibility between pharmacy and clinic systems, technology design issues such as use of auto-populate features and dropdown menus, and inadvertently entering incorrect information. Conclusion Study findings suggest that a wide range of e-prescribing errors are encountered in community pharmacies. Pharmacists and technicians perceive that causes of e-prescribing errors are multidisciplinary and multifactorial, that is to say e-prescribing errors can originate from technology used in prescriber offices and pharmacies. PMID:24657055

  16. Comparison the post operative refractive errors in same size corneal transplantation through deep lamellar keratoplasty and penetrating keratoplasty methods after sutures removing in keratoconus patients

    Directory of Open Access Journals (Sweden)

    Hasan Razmjoo

    2016-01-01

    Full Text Available Background: Corneal transplantation is a surgery in which cornea is replaced by a donated one and can be completely penetrating keratoplasty (PK or included a part of cornea deep lamellar keratoplasty (DLK. Although the functional results are limited by some complications, it is considered as one of the most successful surgeries. This study aimed to compare the refractive errors after same size corneal transplantation through DLK and PK methods in keratoconus patients over 20 years. Materials and Methods: This descriptive, analytical study was conducted in Feiz Hospital, Sadra and Persian Clinics of Isfahan in 2013–2014. In this study, 35 patients underwent corneal transplantation by PK and 35 patients by DLK, after removing the sutures, the patients were compared in terms of best corrected visual acuity (BCVA and refractive errors. Data were analyzed using Chi-square and t Student tests by SPSS software. Results: The BCVA mean in DLK and PK groups was 6/10 ± 2/10 and 5/10 ± 2/10, respectively, with no significant difference (P = 0.4. The results showed 9 cases of DLK and 6 cases of PK had normal (8/10 ≤ BCVA visual acuity (25.7% vs. 17.1%, 24 cases of DLK and 27 cases of PK had mild vision impairment (68.6% vs. 77.1% and 2 cases of the DLK group and 2 cases of PK had moderate vision impairment, (5.7% vs. 5.7%, there was no significant difference in “BCVA” (P = 0.83. Conclusions: Both methods were acceptably effective in improving BCVA, but according to previous articles (5,9,10 the DLK method due to fewer complications and less risk of rejection was superior to another method and in the absence of any prohibition this method is recommended.

  17. Modeling coherent errors in quantum error correction

    Science.gov (United States)

    Greenbaum, Daniel; Dutton, Zachary

    2018-01-01

    Analysis of quantum error correcting codes is typically done using a stochastic, Pauli channel error model for describing the noise on physical qubits. However, it was recently found that coherent errors (systematic rotations) on physical data qubits result in both physical and logical error rates that differ significantly from those predicted by a Pauli model. Here we examine the accuracy of the Pauli approximation for noise containing coherent errors (characterized by a rotation angle ɛ) under the repetition code. We derive an analytic expression for the logical error channel as a function of arbitrary code distance d and concatenation level n, in the small error limit. We find that coherent physical errors result in logical errors that are partially coherent and therefore non-Pauli. However, the coherent part of the logical error is negligible at fewer than {ε }-({dn-1)} error correction cycles when the decoder is optimized for independent Pauli errors, thus providing a regime of validity for the Pauli approximation. Above this number of correction cycles, the persistent coherent logical error will cause logical failure more quickly than the Pauli model would predict, and this may need to be combated with coherent suppression methods at the physical level or larger codes.

  18. Phenotyping for patient safety: algorithm development for electronic health record based automated adverse event and medical error detection in neonatal intensive care.

    Science.gov (United States)

    Li, Qi; Melton, Kristin; Lingren, Todd; Kirkendall, Eric S; Hall, Eric; Zhai, Haijun; Ni, Yizhao; Kaiser, Megan; Stoutenborough, Laura; Solti, Imre

    2014-01-01

    Although electronic health records (EHRs) have the potential to provide a foundation for quality and safety algorithms, few studies have measured their impact on automated adverse event (AE) and medical error (ME) detection within the neonatal intensive care unit (NICU) environment. This paper presents two phenotyping AE and ME detection algorithms (ie, IV infiltrations, narcotic medication oversedation and dosing errors) and describes manual annotation of airway management and medication/fluid AEs from NICU EHRs. From 753 NICU patient EHRs from 2011, we developed two automatic AE/ME detection algorithms, and manually annotated 11 classes of AEs in 3263 clinical notes. Performance of the automatic AE/ME detection algorithms was compared to trigger tool and voluntary incident reporting results. AEs in clinical notes were double annotated and consensus achieved under neonatologist supervision. Sensitivity, positive predictive value (PPV), and specificity are reported. Twelve severe IV infiltrates were detected. The algorithm identified one more infiltrate than the trigger tool and eight more than incident reporting. One narcotic oversedation was detected demonstrating 100% agreement with the trigger tool. Additionally, 17 narcotic medication MEs were detected, an increase of 16 cases over voluntary incident reporting. Automated AE/ME detection algorithms provide higher sensitivity and PPV than currently used trigger tools or voluntary incident-reporting systems, including identification of potential dosing and frequency errors that current methods are unequipped to detect. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  19. Constructing a Patient Education System: A Performance Technology Project

    Science.gov (United States)

    Bell, Edith E.

    2009-01-01

    The purpose of the patient education system described here was to distribute patient education material to and within medical practices managed by a small medical practice management company. The belief was that patient education opportunities improved health care outcomes and increased patient participation in health care decisions and compliance…

  20. Access to Digital Communication Technology and Perceptions of Telemedicine for Patient Education among American Indian Patients with Diabetes.

    Science.gov (United States)

    Mathieson, Kathleen; Leafman, Joan S; Horton, Mark B

    2017-01-01

    Health care access for medically underserved patients managing chronic conditions is challenging. While telemedicine can support patient education and engagement, the "digital divide" may be particularly problematic among the medically underserved. This study evaluated physical access to digital devices, use of e-mail and social media tools, and perceptions of telemedicine among American Indian (AI) patients with diabetes mellitus (DM). Survey data were collected from AI patients with DM during teleophthalmology exams. Eighty-eight percent of patients had access to digital device(s), 70% used e-mail, and 56% used social media. Younger age and greater education were positively associated with e-mail and social media use (p < .05). Most (60%) considered telemedicine an excellent medium for health-related patient education. American Indian patients with DM had access enabling patient education via telemedicine. Future work should examine patient technology preferences and effectiveness of technology-based education in improving outcomes among medically underserved populations.

  1. Medico-legal significance of service difficulties and clinical errors in the management of patients with inflammatory bowel diseases.

    Science.gov (United States)

    Farrukh, Affifa; Mayberry, John F

    2015-03-01

    There is a significant growth in medical litigation, and cases involving the care and management of patients with inflammatory bowel disease are becoming common. There is no central register of such cases, and the majority are settled before court proceedings. As a result, there is no specific case law related to such conditions, and secrecy usually surrounds the outcome with "no admission of guilt" by the defendant and a clause about non-disclosure and discussion linked to the financial compensation received by the claimant. This review discusses common areas of potential litigation. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  2. Prosthetic Smart Socket Technology to Improve Patient Interaction, Usability, Comfort, Fit and Function

    Science.gov (United States)

    2017-10-01

    impact on society beyond science and technology ? Nothing to report at this time. 5. CHANGES/PROBLEMS: Changes in approach and reasons for...AWARD NUMBER: W81XWH-16-1-0785 TITLE: Prosthetic Smart Socket Technology to Improve Patient Interaction, Usability, Comfort, Fit and Function...2016 - 29 Sep 2017 4. TITLE AND SUBTITLE Prosthetic Smart Socket Technology to Improve Patient Interaction, Usability, Comfort, Fit and Function 5a

  3. Implementing shared governance in a patient care support industry: information technology leading the way.

    Science.gov (United States)

    Hartley, Lou Ann

    2014-06-01

    Implementing technology in the clinical setting is not a project but rather a journey in transforming care delivery. As nursing leaders in healthcare and patient care support organizations embrace technology to drive reforms in quality and efficiency, growing opportunities exist to share experiences between these industries. This department submission describes the journey to nursing shared governance from the perspective of an information technology-based company realizing the goal of supporting patient care.

  4. Distributed Computing and Monitoring Technologies for Older Patients

    DEFF Research Database (Denmark)

    Klonovs, Juris; Haque, Mohammad Ahsanul; Krüger, Volker

    , telemonitoring, ambient intelligence, ambient assisted living, gerontechnology, and aging-in-place technology. The book discusses relevant experimental studies, highlighting the application of sensor fusion, signal processing and machine learning techniques. Finally, the text discusses future challenges...

  5. Radio Frequency Identification (RFID) technology and patient safety

    OpenAIRE

    Ajami, Sima; Rajabzadeh, Ahmad

    2013-01-01

    Background: Radio frequency identification (RFID) systems have been successfully applied in areas of manufacturing, supply chain, agriculture, transportation, healthcare, and services to name a few. However, the different advantages and disadvantages expressed in various studies of the challenges facing the technology of the use of the RFID technology have been met with skepticism by managers of healthcare organizations. The aim of this study was to express and display the role of RFID techno...

  6. [Technology in the nurse-patient relationship in diabetology, a true metronome?].

    Science.gov (United States)

    Desserprix, Agnès

    2016-03-01

    Technology is evolving to keep pace with patients' and caregivers' needs and advances in research. In diabetology, this progress concerns administration systems, the devices for monitoring blood sugar levels, accessories and technical support, and provides hope for tomorrow. In this context, it is essential that the patient remains at the centre of the nurse-patient relationship and that technology remains simply a source of reference points and comfort. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  7. Emerging role of digital technology and remote monitoring in the care of cardiac patients.

    Science.gov (United States)

    Banchs, Javier E; Scher, David Lee

    2015-07-01

    Current available mobile health technologies make possible earlier diagnosis and long-term monitoring of patients with cardiovascular diseases. Remote monitoring of patients with implantable devices and chronic diseases has resulted in better outcomes reducing health care costs and hospital admissions. New care models, which shift point of care to the outpatient setting and the patient's home, necessitate innovations in technology. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Barriers to medical error reporting

    Directory of Open Access Journals (Sweden)

    Jalal Poorolajal

    2015-01-01

    Full Text Available Background: This study was conducted to explore the prevalence of medical error underreporting and associated barriers. Methods: This cross-sectional study was performed from September to December 2012. Five hospitals, affiliated with Hamadan University of Medical Sciences, in Hamedan,Iran were investigated. A self-administered questionnaire was used for data collection. Participants consisted of physicians, nurses, midwives, residents, interns, and staffs of radiology and laboratory departments. Results: Overall, 50.26% of subjects had committed but not reported medical errors. The main reasons mentioned for underreporting were lack of effective medical error reporting system (60.0%, lack of proper reporting form (51.8%, lack of peer supporting a person who has committed an error (56.0%, and lack of personal attention to the importance of medical errors (62.9%. The rate of committing medical errors was higher in men (71.4%, age of 50-40 years (67.6%, less-experienced personnel (58.7%, educational level of MSc (87.5%, and staff of radiology department (88.9%. Conclusions: This study outlined the main barriers to reporting medical errors and associated factors that may be helpful for healthcare organizations in improving medical error reporting as an essential component for patient safety enhancement.

  9. Patients' Acceptance of Smartphone Health Technology for Chronic Disease Management: A Theoretical Model and Empirical Test.

    Science.gov (United States)

    Dou, Kaili; Yu, Ping; Deng, Ning; Liu, Fang; Guan, YingPing; Li, Zhenye; Ji, Yumeng; Du, Ningkai; Lu, Xudong; Duan, Huilong

    2017-12-06

    Chronic disease patients often face multiple challenges from difficult comorbidities. Smartphone health technology can be used to help them manage their conditions only if they accept and use the technology. The aim of this study was to develop and test a theoretical model to predict and explain the factors influencing patients' acceptance of smartphone health technology for chronic disease management. Multiple theories and factors that may influence patients' acceptance of smartphone health technology have been reviewed. A hybrid theoretical model was built based on the technology acceptance model, dual-factor model, health belief model, and the factors identified from interviews that might influence patients' acceptance of smartphone health technology for chronic disease management. Data were collected from patient questionnaire surveys and computer log records about 157 hypertensive patients' actual use of a smartphone health app. The partial least square method was used to test the theoretical model. The model accounted for .412 of the variance in patients' intention to adopt the smartphone health technology. Intention to use accounted for .111 of the variance in actual use and had a significant weak relationship with the latter. Perceived ease of use was affected by patients' smartphone usage experience, relationship with doctor, and self-efficacy. Although without a significant effect on intention to use, perceived ease of use had a significant positive influence on perceived usefulness. Relationship with doctor and perceived health threat had significant positive effects on perceived usefulness, countering the negative influence of resistance to change. Perceived usefulness, perceived health threat, and resistance to change significantly predicted patients' intentions to use the technology. Age and gender had no significant influence on patients' acceptance of smartphone technology. The study also confirmed the positive relationship between intention to use

  10. Learning from prescribing errors

    OpenAIRE

    Dean, B

    2002-01-01

    

 The importance of learning from medical error has recently received increasing emphasis. This paper focuses on prescribing errors and argues that, while learning from prescribing errors is a laudable goal, there are currently barriers that can prevent this occurring. Learning from errors can take place on an individual level, at a team level, and across an organisation. Barriers to learning from prescribing errors include the non-discovery of many prescribing errors, lack of feedback to th...

  11. Leaving patients to their own devices? Smart technology, safety and therapeutic relationships.

    Science.gov (United States)

    Ho, Anita; Quick, Oliver

    2018-03-06

    This debate article explores how smart technologies may create a double-edged sword for patient safety and effective therapeutic relationships. Increasing utilization of health monitoring devices by patients will likely become an important aspect of self-care and preventive medicine. It may also help to enhance accurate symptom reports, diagnoses, and prompt referral to specialist care where appropriate. However, the development, marketing, and use of such technology raise significant ethical implications for therapeutic relationships and patient safety. Drawing on lessons learned from other direct-to-consumer health products such as genetic testing, this article explores how smart technology can also pose regulatory challenges and encourage overutilization of healthcare services. In order for smart technology to promote safer care and effective therapeutic encounters, the technology and its utilization must be safe. This article argues for unified regulatory guidelines and better education for both healthcare providers and patients regarding the benefits and risks of these devices.

  12. Patient monitoring in Polish assisted reproductive technology centres

    Directory of Open Access Journals (Sweden)

    Anna Krawczak

    2016-12-01

    Full Text Available In 2014, the Polish non-governmental patient association ‘Our Stork’ (Nasz Bocian introduced the ‘Patient monitoring in ART centres’ research project to gather previously unrecorded information on the situation of infertile people and the provision of assisted reproductive treatment in Poland. When the research project began, assisted reproductive treatment centres were unregulated by the state, a situation that had existed for more than 28 years following the birth of the first Polish test-tube baby in 1987. Patients signed civil contracts, remaining unprotected in terms of safety of treatment and recognition of their rights, and their presumed social position was described by doctors as ‘disciplined patients’ – a reflection of what Michele Foucault described as biopolitics. The research project comprised patient questionnaires (responses from 722 patients provided the basis for the document ‘Patient Recommendations in Infertility Treatment’, analysis of civil contracts and their accuracy in the context of patients’ legal rights in Poland, and in-depth interviews with assisted reproductive treatment centres’ owners, doctors, midwives, and patients to explore patient care. The data reveal that there is a lack of patient-centred care among doctors and medical staff in Poland and that following the passing into law of the 2015 Infertility Act, which introduced state regulation of assisted reproductive treatment centres, the situation for patients worsened.

  13. Designing Patient-facing Health Information Technologies for the Outpatient Settings: A Literature Review

    OpenAIRE

    Yushi Yang; Onur Asan

    2016-01-01

    Introduction: The implementation of health information technologies (HITs) has changed the dynamics of doctor–patient communication in outpatient settings. Designing patient-facing HITs provides patients with easy access to healthcare information during the visit and has the potential to enhance the patient-centred care.   Objectives: The objectives of this study are to systematically review how the designs of patient-facing HITs have been suggested and evaluated, and how they may pot...

  14. Implementation of Technology-based Patient Engagement Strategies within Practice-based Research Networks.

    Science.gov (United States)

    Careyva, Beth; Shaak, Kyle; Mills, Geoffrey; Johnson, Melanie; Goodrich, Samantha; Stello, Brian; Wallace, Lorraine S

    2016-01-01

    Technology-based patient engagement strategies (such as patient portals) are increasingly available, yet little is known about current use and barriers within practice-based research networks (PBRNs). PBRN directors have unique opportunities to inform the implementation of patient-facing technology and to translate these findings into practice. PBRN directors were queried regarding technology-based patient engagement strategies as part of the 2015 CAFM Educational Research Alliance (CERA) survey of PBRN directors. A total of 102 PBRN directors were identified via the Agency for Healthcare Research and Quality's registry; 54 of 96 eligible PBRN directors completed the survey, for a response rate of 56%. Use of technology-based patient engagement strategies within PBRNs was limited, with less than half of respondents reporting experience with the most frequently named tools (risk assessments/decision aids). Information technology (IT) support was the top barrier, followed by low rates of portal enrollment. For engaging participant practices, workload and practice leadership were cited as most important, with fewer respondents noting concerns about patient privacy. Given limited use of patient-facing technologies, PBRNs have an opportunity to clarify the optimal use of these strategies. Providing IT support and addressing clinician concerns regarding workload may facilitate the inclusion of innovative technologies in PBRNs. © Copyright 2016 by the American Board of Family Medicine.

  15. Analysis and reduction of 3D systematic and random setup errors during the simulation and treatment of lung cancer patients with CT-based external beam radiotherapy dose planning.

    NARCIS (Netherlands)

    Boer, H.D. de; Sornsen de Koste, J.R. van; Senan, S.; Visser, A.G.; Heijmen, B.J.M.

    2001-01-01

    PURPOSE: To determine the magnitude of the errors made in (a) the setup of patients with lung cancer on the simulator relative to their intended setup with respect to the planned treatment beams and (b) in the setup of these patients on the treatment unit. To investigate how the systematic component

  16. Empowering Patients with COPD Using Tele-Homecare Technology

    DEFF Research Database (Denmark)

    Huniche, Lotte

    2010-01-01

    Abstract. This paper describes how a tele-rehabilitation program using home tele-monitoring empowers patients with COPD. The paper is based on findings from an ongoing research and innovation project, called “Telehomecare, chronic patients and the integrated healthcare system” (the TELEKAT project......) that employs triple interventions related to patients, professionals, and the organisation of care. The ways COPD patients utilize home tele-monitoring in the TELEKAT project points to the relevance of empowerment, as rooted in ideologies of social action, and focusing on the improvement of both personal...

  17. Information technology-based standardized patient education in psychiatric inpatient care.

    Science.gov (United States)

    Anttila, Minna; Koivunen, Marita; Välimäki, Maritta

    2008-10-01

    This paper is a report of a study to describe nurses' experiences of information technology-based standardized patient education in inpatient psychiatric care. Serious mental health problems are an increasing global concern. Emerging evidence supports the implementation of practices that are conducive to patient self-management and improved patient outcomes among chronically ill patients with mental health problems. In contrast, the attitude of staff towards information technology has been reported to be contradictory in mental health care. After 1 year of using an Internet-based portal (Mieli.Net) developed for patients with schizophrenia spectrum psychosis, all 89 participating nurses were asked to complete questionnaires about their experiences. The data were collected in 2006. Fifty-six participants (63%) returned completed questionnaires and the data were analysed using content analysis. Nurses' experiences of the information technology-based standardized patient education were categorized into two major categories describing the advantages and obstacles in using information technology. Nurses thought that it brought the patients and nurses closer to each other and helped nurses to provide individual support for their patients. However, the education was time-consuming. Systematic patient education using information technology is a promising method of patient-centred care which supports nurses in their daily work. However, it must fit in with clinical activities, and nurses need some guidance in understanding its benefits. The study data can be used in policy-making when developing methods to improve the transparency of information provision in psychiatric nursing.

  18. Effectiveness of educational technology to improve patient care in pharmacy curricula.

    Science.gov (United States)

    Smith, Michael A; Benedict, Neal

    2015-02-17

    A review of the literature on the effectiveness of educational technologies to teach patient care skills to pharmacy students was conducted. Nineteen articles met inclusion criteria for the review. Seven of the articles included computer-aided instruction, 4 utilized human-patient simulation, 1 used both computer-aided instruction and human-patient simulation, and 7 utilized virtual patients. Educational technology was employed with more than 2700 students at 12 colleges and schools of pharmacy in courses including pharmacotherapeutics, skills and patient care laboratories, drug diversion, and advanced pharmacy practice experience (APPE) orientation. Students who learned by means of human-patient simulation and virtual patients reported enjoying the learning activity, whereas the results with computer-aided instruction were mixed. Moreover, the effect on learning was significant in the human-patient simulation and virtual patient studies, while conflicting data emerged on the effectiveness of computer-aided instruction.

  19. Distributed Computing and Monitoring Technologies for Older Patients

    DEFF Research Database (Denmark)

    Klonovs, Juris; Haque, Mohammad Ahsanul; Krueger, Volker

    This book summarizes various approaches for the automatic detection of health threats to older patients at home living alone. The text begins by briefly describing those who would most benefit from healthcare supervision. The book then summarizes possible scenarios for monitoring an older patient...

  20. The sensitivity of gamma-index method to the positioning errors of high-definition MLC in patient-specific VMAT QA for SBRT

    International Nuclear Information System (INIS)

    Kim, Jung-in; Park, So-Yeon; Kim, Hak Jae; Kim, Jin Ho; Ye, Sung-Joon; Park, Jong Min

    2014-01-01

    To investigate the sensitivity of various gamma criteria used in the gamma-index method for patient-specific volumetric modulated arc therapy (VMAT) quality assurance (QA) for stereotactic body radiation therapy (SBRT) using a flattening filter free (FFF) photon beam. Three types of intentional misalignments were introduced to original high-definition multi-leaf collimator (HD-MLC) plans. The first type, referred to Class Out, involved the opening of each bank of leaves. The second type, Class In, involved the closing of each bank of leaves. The third type, Class Shift, involved the shifting of each bank of leaves towards the ground. Patient-specific QAs for the original and the modified plans were performed with MapCHECK2 and EBT2 films. The sensitivity of the gamma-index method using criteria of 1%/1 mm, 1.5%/1.5 mm, 1%/2 mm, 2%/1 mm and 2%/2 mm was investigated with absolute passing rates according to the magnitudes of MLCs misalignments. In addition, the changes in dose-volumetric indicators due to the magnitudes of MLC misalignments were investigated. The correlations between passing rates and the changes in dose-volumetric indicators were also investigated using Spearman’s rank correlation coefficient (γ). The criterion of 2%/1 mm was able to detect Class Out and Class In MLC misalignments of 0.5 mm and Class Shift misalignments of 1 mm. The widely adopted clinical criterion of 2%/2 mm was not able to detect 0.5 mm MLC errors of the Class Out or Class In types, and also unable to detect 3 mm Class Shift errors. No correlations were observed between dose-volumetric changes and gamma passing rates (γ < 0.8). Gamma criterion of 2%/1 mm was found to be suitable as a tolerance level with passing rates of 90% and 80% for patient-specific VMAT QA for SBRT when using MapCHECK2 and EBT2 film, respectively

  1. Spectrum of diagnostic errors in radiology

    OpenAIRE

    Pinto, Antonio; Brunese, Luca

    2010-01-01

    Diagnostic errors are important in all branches of medicine because they are an indication of poor patient care. Since the early 1970s, physicians have been subjected to an increasing number of medical malpractice claims. Radiology is one of the specialties most liable to claims of medical negligence. Most often, a plaintiff’s complaint against a radiologist will focus on a failure to diagnose. The etiology of radiological error is multi-factorial. Errors fall into recurrent patterns. Errors ...

  2. Phenylketonuria as a model for protein misfolding diseases and for the development of next generation orphan drugs for patients with inborn errors of metabolism.

    Science.gov (United States)

    Muntau, Ania C; Gersting, Søren W

    2010-12-01

    The lecture dedicated to Professor Horst Bickel describes the advances, successes, and opportunities concerning the understanding of the biochemical and molecular basis of phenylketonuria and the innovative treatment strategies introduced for these patients during the last 60 years. These concepts were transferred to other inborn errors of metabolism and led to significant reduction in morbidity and to an improvement in quality of life. Important milestones were the successful development of a low-phenylalanine diet for phenylketonuria patients, the recognition of tetrahydrobiopterin as an option to treat these individuals pharmacologically, and finally market approval of this drug. The work related to the discovery of a pharmacological treatment led metabolic researchers and pediatricians to new insights into the molecular processes linked to mutations in the phenylalanine hydroxylase gene at the cellular and structural level. Again, phenylketonuria became a prototype disorder for a previously underestimated but now rapidly expanding group of diseases: protein misfolding disorders with loss of function. Due to potential general biological mechanisms underlying these disorders, the door may soon open to a systematic development of a new class of pharmaceutical products. These pharmacological chaperones are likely to correct misfolding of proteins involved in numerous genetic and nongenetic diseases.

  3. Patients' experiences with technology during inpatient rehabilitation: opportunities to support independence and therapeutic engagement.

    Science.gov (United States)

    Fager, Susan Koch; Burnfield, Judith M

    2014-03-01

    To understand individuals' perceptions of technology use during inpatient rehabilitation. A qualitative phenomenological study using semi-structured interviews of 10 individuals with diverse underlying diagnoses and/or a close family member who participated in inpatient rehabilitation. Core themes focused on assistive technology usage (equipment set-up, reliability and fragility of equipment, expertise required to use assistive technology and use of mainstream technologies) and opportunities for using technology to increase therapeutic engagement (opportunities for practice outside of therapy, goals for therapeutic exercises and technology for therapeutic exercises: motivation and social interaction). Interviews revealed the need for durable, reliable and intuitive technology without requiring a high level of expertise to install and implement. A strong desire for the continued use of mainstream devices (e.g. cell phones, tablet computers) reinforces the need for a wider range of access options for those with limited physical function. Finally, opportunities to engage in therapeutically meaningful activities beyond the traditional treatment hours were identified as valuable for patients to not only improve function but to also promote social interaction. Assistive technology increases functional independence of severely disabled individuals. End-users (patients and families) identified a need for designs that are durable, reliable, intuitive, easy to consistently install and use. Technology use (adaptive or commercially available) provides a mechanism to extend therapeutic practice beyond the traditional therapy day. Adapting skeletal tracking technology used in gaming software could automate exercise tracking, documentation and feedback for patient motivation and clinical treatment planning and interventions.

  4. Quality of life, psychological adjustment, and adaptive functioning of patients with intoxication-type inborn errors of metabolism - a systematic review.

    Science.gov (United States)

    Zeltner, Nina A; Huemer, Martina; Baumgartner, Matthias R; Landolt, Markus A

    2014-10-25

    In recent decades, considerable progress in diagnosis and treatment of patients with intoxication-type inborn errors of metabolism (IT-IEM) such as urea cycle disorders (UCD), organic acidurias (OA), maple syrup urine disease (MSUD), or tyrosinemia type 1 (TYR 1) has resulted in a growing group of long-term survivors. However, IT-IEM still require intense patient and caregiver effort in terms of strict dietetic and pharmacological treatment, and the threat of metabolic crises is always present. Furthermore, crises can affect the central nervous system (CNS), leading to cognitive, behavioural and psychiatric sequelae. Consequently, the well-being of the patients warrants consideration from both a medical and a psychosocial viewpoint by assessing health-related quality of life (HrQoL), psychological adjustment, and adaptive functioning. To date, an overview of findings on these topics for IT-IEM is lacking. We therefore aimed to systematically review the research on HrQoL, psychological adjustment, and adaptive functioning in patients with IT-IEM. Relevant databases were searched with predefined keywords. Study selection was conducted in two steps based on predefined criteria. Two independent reviewers completed the selection and data extraction. Eleven articles met the inclusion criteria. Studies were of varying methodological quality and used different assessment measures. Findings on HrQoL were inconsistent, with some showing lower and others showing higher or equal HrQoL for IT-IEM patients compared to norms. Findings on psychological adjustment and adaptive functioning were more consistent, showing mostly either no difference or worse adjustment of IT-IEM patients compared to norms. Single medical risk factors for HrQoL, psychological adjustment, or adaptive functioning have been addressed, while psychosocial risk factors have not been addressed. Data on HrQoL, psychological adjustment, and adaptive functioning for IT-IEM are sparse. Studies are inconsistent in

  5. Barriers and facilitators to recovering from e-prescribing errors in community pharmacies.

    Science.gov (United States)

    Odukoya, Olufunmilola K; Stone, Jamie A; Chui, Michelle A

    2015-01-01

    To explore barriers and facilitators to recovery from e-prescribing errors in community pharmacies and to explore practical solutions for work system redesign to ensure successful recovery from errors. Cross-sectional qualitative design using direct observations, interviews, and focus groups. Five community pharmacies in Wisconsin. 13 pharmacists and 14 pharmacy technicians. Observational field notes and transcribed interviews and focus groups were subjected to thematic analysis guided by the Systems Engineering Initiative for Patient Safety (SEIPS) work system and patient safety model. Barriers and facilitators to recovering from e-prescription errors in community pharmacies. Organizational factors, such as communication, training, teamwork, and staffing levels, play an important role in recovering from e-prescription errors. Other factors that could positively or negatively affect recovery of e-prescription errors include level of experience, knowledge of the pharmacy personnel, availability or usability of tools and technology, interruptions and time pressure when performing tasks, and noise in the physical environment. The SEIPS model sheds light on key factors that may influence recovery from e-prescribing errors in pharmacies, including the environment, teamwork, communication, technology, tasks, and other organizational variables. To be successful in recovering from e-prescribing errors, pharmacies must provide the appropriate working conditions that support recovery from errors.

  6. Two-dimensional errors

    International Nuclear Information System (INIS)

    Anon.

    1991-01-01

    This chapter addresses the extension of previous work in one-dimensional (linear) error theory to two-dimensional error analysis. The topics of the chapter include the definition of two-dimensional error, the probability ellipse, the probability circle, elliptical (circular) error evaluation, the application to position accuracy, and the use of control systems (points) in measurements

  7. Part two: Error propagation

    International Nuclear Information System (INIS)

    Picard, R.R.

    1989-01-01

    Topics covered in this chapter include a discussion of exact results as related to nuclear materials management and accounting in nuclear facilities; propagation of error for a single measured value; propagation of error for several measured values; error propagation for materials balances; and an application of error propagation to an example of uranium hexafluoride conversion process

  8. Learning from Errors

    OpenAIRE

    Martínez-Legaz, Juan Enrique; Soubeyran, Antoine

    2003-01-01

    We present a model of learning in which agents learn from errors. If an action turns out to be an error, the agent rejects not only that action but also neighboring actions. We find that, keeping memory of his errors, under mild assumptions an acceptable solution is asymptotically reached. Moreover, one can take advantage of big errors for a faster learning.

  9. Proprioception rehabilitation training system for stroke patients using virtual reality technology.

    Science.gov (United States)

    Kim, Sun I; Song, In-Ho; Cho, Sangwoo; Kim, In Young; Ku, Jeonghun; Kang, Youn Joo; Jang, Dong Pyo

    2013-01-01

    We investigated a virtual reality (VR) proprioceptive rehabilitation system that could manipulate the visual feedback of upper-limb during training and could do training by relying on proprioception feedback only. Virtual environments were designed in order to switch visual feedback on/off during upper-limb training. Two types of VR training tasks were designed for evaluating the effect of the proprioception focused training compared to the training with visual feedback. In order to evaluate the developed proprioception feedback virtual environment system, we recruited ten stroke patients (age: 54.7± 7.83years, on set: 3.29± 3.83 years). All patients performed three times PFVE task in order to check the improvement of proprioception function just before training session, after one week training, and after all training. In a comparison between FMS score and PFVE, the FMS score had a significant relationship with the error distance(r = -.662, n=10, p = .037) and total movement distance(r = -.726, n=10, p = .018) in PFVE. Comparing the training effect between in virtual environment with visual feedback and with proprioception, the click count, error distance and total error distance was more reduced in PFVE than VFVE. (Click count: p = 0.005, error distance: p = 0.001, total error distance: p = 0.007). It suggested that the proprioception feedback rather than visual feedback could be effective means to enhancing motor control during rehabilitation training. The developed VR system for rehabilitation has been verified in that stroke patients improved motor control after VR proprioception feedback training.

  10. Ophthalmic patients' utilization of technology and social media: an assessment to improve quality of care.

    Science.gov (United States)

    Aleo, Chelsea L; Hark, Lisa; Leiby, Benjamin; Dai, Yang; Murchison, Ann P; Martinez, Patricia; Haller, Julia A

    2014-10-01

    E-health tools have the potential to improve the quality of care for ophthalmic patients, many of whom have chronic conditions. However, little research has assessed ophthalmic patients' use or acceptance of technological devices and social media platforms for health-related purposes. The present study evaluated utilization of technological devices and social media platforms by eye clinic patients, as well as their willingness to receive health reminders through these technologies. A 31-item paper questionnaire was administered to eye clinic patients (n=843) at an urban, tertiary-care center. Questions focused on technology ownership, comfort levels, frequency of use, and preferences for receiving health reminders. Demographic data were also recorded. Eye clinic patients most commonly owned cellular phones (90%), landline phones (81%), and computers (80%). Overall, eye clinic patients preferred to receive health reminders through phone calls and e-mail and used these technologies frequently and with a high level of comfort. Less than 3% of patients preferred using social networking to receive health reminders. In addition, age was significantly associated with technology ownership, comfort level, and frequency of use (ptechnologies more frequently and with a higher comfort level (ptechnologies for appointment reminders, general eye and vision health information, asking urgent medical questions, and requesting prescription refills. Future controlled trials could further explore the efficacy of e-health tools for these purposes.

  11. Patient handover in orthopaedics, improving safety using Information Technology.

    Science.gov (United States)

    Pearkes, Tim

    2015-01-01

    Good inpatient handover ensures patient safety and continuity of care. An adjunct to this is the patient list which is routinely managed by junior doctors. These lists are routinely created and managed within Microsoft Excel or Word. Following the merger of two orthopaedic departments into a single service in a new hospital, it was felt that a number of safety issues within the handover process needed to be addressed. This quality improvement project addressed these issues through the creation and implementation of a new patient database which spanned the department, allowing trouble free, safe, and comprehensive handover. Feedback demonstrated an improved user experience, greater reliability, continuity within the lists and a subsequent improvement in patient safety.

  12. Generalized Gaussian Error Calculus

    CERN Document Server

    Grabe, Michael

    2010-01-01

    For the first time in 200 years Generalized Gaussian Error Calculus addresses a rigorous, complete and self-consistent revision of the Gaussian error calculus. Since experimentalists realized that measurements in general are burdened by unknown systematic errors, the classical, widespread used evaluation procedures scrutinizing the consequences of random errors alone turned out to be obsolete. As a matter of course, the error calculus to-be, treating random and unknown systematic errors side by side, should ensure the consistency and traceability of physical units, physical constants and physical quantities at large. The generalized Gaussian error calculus considers unknown systematic errors to spawn biased estimators. Beyond, random errors are asked to conform to the idea of what the author calls well-defined measuring conditions. The approach features the properties of a building kit: any overall uncertainty turns out to be the sum of a contribution due to random errors, to be taken from a confidence inter...

  13. Medical errors in hospitalized patients

    OpenAIRE

    Carvalho, Manoel de; Vieira, Alan A.

    2002-01-01

    Objetivo: o presente artigo tem por objetivo revisar a literatura e discutir a questão do erro médico em pacientes hospitalizados, enfocando sua conceituação, incidência, fatores predisponentes e mecanismos de prevenção. Aborda, em especial, erros e eventos adversos com drogas envolvendo recém-nascidos e pacientes pediátricos. Métodos: revisão bibliográfica utilizando banco de dados Medline, selecionando-se aqueles com informações atuais e relevantes. Resultados:mesmo assumindo que a notifica...

  14. Retinopatia da prematuridade: achados refrativos pós-tratamento com crioterapia ou laser Retinopathy of prematurity: refractive errors in patients treated with cryotherapy or laser

    Directory of Open Access Journals (Sweden)

    Sara Pozzi

    2000-10-01

    Full Text Available Objetivos: Determinar e comparar as características refrativas de uma população composta de crianças pré-termo com retinopatia da prematuridade que necessitaram de tratamento com crioterapia ou laserterapia. Método: Análise dos resultados da refração estática de 14 pacientes (de um total de 761 fichas de crianças que nasceram no Hospital São Paulo da Universidade Federal de São Paulo - Escola Paulista de Medicina, entre janeiro de 1988 e abril de 1998, que completaram um ano de idade e que apresentaram Retinopatia da Prematuridade grau 3 com características de "doença limiar" sendo tratadas com crioterapia ou laserterapia. Foram utilizados os testes estatísticos de Wilcoxon e Mann-Whitney para a avaliação dos resultados. Resultados: 64,3% dos pacientes apresentaram miopia. No grupo de pacientes que receberam tratamento com crioterapia, 80% mostrou miopia, que em todos os casos foi alta; 20% hipermetropia leve, com uma média para o equivalente esférico de --3,10 D no olho direito e --3,25 D no olho esquerdo (diferença entre ambos os olhos estatísticamente não significante. No grupo de laserterapia, 55,6% mostrou miopia, sendo 20 % dos casos miopia alta e 80% miopia leve; 11,1% apresentou-se sem ametropia e 33,3 % com hipermetropia leve. O valor da média para o equivalente esférico foi --0,58 D no olho direito e --0,83D no olho esquerdo (diferença entre ambos os olhos estatisticamente significante. A comparação dos resultados refracionais dos dois grupos mostrou uma maior incidência para miopia alta no grupo de pacientes que receberam tratamento com crioterapia (PPurpose: To examine the spherical equivalent of refractive errors in preterm children with threshold retinopathy of prematurity treated with cryotherapy or laser. Patients and Method: A group of 14 one-year-old children (selected from 761 preterm children born at the Hospital São Paulo of the Universidade Federal de São Paulo between 1988 and 1998 with stage

  15. Organization-and-technological model of medical care delivered to patients with arterial hypertension

    Directory of Open Access Journals (Sweden)

    Kiselev A.R.

    2014-09-01

    Full Text Available Organization-and-technological model of medical care delivered to patients with arterial hypertension based on IDEF0 methodology and corresponded with clinical guidelines is presented.

  16. Organization-and-technological model of medical care delivered to patients with chronic heart failure

    Directory of Open Access Journals (Sweden)

    Kiselev A.R.

    2014-09-01

    Full Text Available Organization-and-technological model of medical care delivered to patients with chronic heart failure based on IDEF0 methodology and corresponded with clinical guidelines is presented.

  17. Organization-and-technological model of medical care delivered to patients with coronary heart disease

    Directory of Open Access Journals (Sweden)

    Popova Y.V.

    2014-09-01

    Full Text Available Organization-and-technological model of medical care delivered to patients with coronary heart disease based on IDEF0 methodology and corresponded with clinical guidelines is presented.

  18. Heart failure patients' perceptions and use of technology to manage disease symptoms.

    Science.gov (United States)

    Hall, Amanda K; Dodd, Virginia; Harris, Amy; McArthur, Kara; Dacso, Clifford; Colton, Lara M

    2014-04-01

    Technology use for symptom management is beneficial for both patients and physicians. Widespread acceptance of technology use in healthcare fuels continued development of technology with ever-increasing sophistication. Although acceptance of technology use in healthcare by medical professionals is evident, less is known about the perceptions, preferences, and use of technology by heart failure (HF) patients. This study explores patients' perceptions and current use of technology for managing HF symptoms (MHFS). A qualitative analysis of in-depth individual interviews using a constant comparative approach for emerging themes was conducted. Fifteen participants (mean age, 64.43 years) with HF were recruited from hospitals, cardiology clinics, and community groups. All study participants reported use of a home monitoring device, such as an ambulatory blood pressure device or bathroom scale. The majority of participants reported not accessing online resources for additional MHFS information. However, several participants stated their belief that technology would be useful for MHFS. Participants reported increased access to care, earlier indication of a worsening condition, increased knowledge, and greater convenience as potential benefits of technology use while managing HF symptoms. For most participants financial cost, access issues, satisfaction with current self-care routine, mistrust of technology, and reliance on routine management by their current healthcare provider precluded their use of technology for MHFS. Knowledge about HF patients' perceptions of technology use for self-care and better understanding of issues associated with technology access can aid in the development of effective health behavior interventions for individuals who are MHFS and may result in increased compliance, better outcomes, and lower healthcare costs.

  19. Online self-management interventions for chronically ill patients: cognitive impairment and technology issues.

    Science.gov (United States)

    Archer, Norm; Keshavjee, Karim; Demers, Catherine; Lee, Ryan

    2014-04-01

    As the fraction of the population with chronic diseases continues to grow, methods and/or technologies must be found to help the chronically ill to take more responsibility to self-manage their illnesses. Internet based and/or mobile support for disease self-management interventions have often proved effective, but patients with chronic illnesses may have co-occurring cognitive impairment, making it more difficult for them to cope with technologies. Many older patients are also not familiar with technologies or they may have cognitive disabilities or dementia that reduce their ability to self-manage their healthcare. On-line solutions to the needs of chronically ill patients must be investigated and acted upon with care in an integrated manner, since resources invested in these solutions will be lost if patients do not adopt and continue to use them successfully. To review the capabilities of online and mobile support for self-management of chronic illnesses, and the impacts that age and disease-related issues have on these interventions, including cognitive impairment and lack of access or familiarity with Internet or mobile technologies. This study includes a review of the co-occurrence of cognitive impairment with chronic diseases, and discusses how cognitive impairment, dyadic caregiver patient support, patient efficacy with technology, and smart home technologies can impact the effectiveness and sustainability of online support for disease self-management. Disease self-management interventions (SMIs) using online patient centered support can often enable patients to manage their own chronic illnesses. However, our findings show that cognitive impairment often co-occurs in patients with chronic disease. This, along with age-related increases in multiple chronic illnesses and lack of technology efficacy, can be obstacles to Internet and mobile support for chronic disease self-management. Patients with chronic diseases may have greater than expected difficulties

  20. Teleheath Technology as E-Learning: Learning and Practicing Interprofessional Patient Care

    Science.gov (United States)

    Shortridge, Ann; Ross, Heather; Randall, Ken; Ciro, Carrie; Loving, Gary

    2018-01-01

    Teaching team-based patient competencies to health sciences students has proven to be a challenging endeavor. This paper describes two hands-on learning experiences and their subsequent evaluation. In both of these experiences telehealth technology served as both a distance education e-learning technology, as well as a medium to provide patient…

  1. Dual-therapy stent technology for patients with coronary artery disease : A great catch?

    NARCIS (Netherlands)

    Kalkman, D.N.

    2018-01-01

    This thesis investigates the possible advantages of a new stent technology that aims to improve care for patients with coronary artery disease. The COMBO stent (OrbusNeich Medical BV, The Netherlands) contains a dual-therapy stent technology. The stent combines two techniques: a sirolimus-elution

  2. Innovative technology for colostomy irrigation: assessing the impact on patients.

    Science.gov (United States)

    Pace, S; Manuini, F; Maculotti, D

    2015-10-01

    The main purpose of the trial was to evaluate the opinions expressed by a sample of subjects with permanent colostomy, as a result of the use of a new device designed for the execution of transtomal intestinal irrigation; their feedback was analyzed in relation to the concept of Quality of Life. The device was tested on a sample of 14 colostomized patients (10 men and 4 women, aged between 42 and 77 years) who were used to perform intestinal irrigation procedures independently and routinely, with standard technique. After testing the new device, the patients included in the study were asked to fill out a questionnaire built ad hoc for their situation. The analysis of the data collected led to the following conclusions: 93% of the patients described the new irrigation method as simpler than the standard procedure; the majority of the patients assessed bowel emptying as good; 64% of patients reported excellent comfort experienced during the procedure; the presence of a regulator to adjust the instillation speed of water into the intestinal lumen was considered useful to control the flow of the incoming fluid The use of the device guaranteed: psychological tranquility, minimum manual intervention, full achievement of the expected results and decrease in the issues normally encountered with the standard irrigation method. The practical features of the new device ensure easy and straightforward carrying out of the procedure; this ease of use affects the stomized patient's everyday life by reducing the time of procedure completion, thus positively influencing the perception of the patients' Quality of Life.

  3. The use of information technology to enhance patient safety and nursing efficiency.

    Science.gov (United States)

    Lee, Tso-Ying; Sun, Gi-Tseng; Kou, Li-Tseng; Yeh, Mei-Ling

    2017-10-23

    Issues in patient safety and nursing efficiency have long been of concern. Advancing the role of nursing informatics is seen as the best way to address this. The aim of this study was to determine if the use, outcomes and satisfaction with a nursing information system (NIS) improved patient safety and the quality of nursing care in a hospital in Taiwan. This study adopts a quasi-experimental design. Nurses and patients were surveyed by questionnaire and data retrieval before and after the implementation of NIS in terms of blood drawing, nursing process, drug administration, bar code scanning, shift handover, and information and communication integration. Physiologic values were easier to read and interpret; it took less time to complete electronic records (3.7 vs. 9.1 min); the number of errors in drug administration was reduced (0.08% vs. 0.39%); bar codes reduced the number of errors in blood drawing (0 vs. 10) and transportation of specimens (0 vs. 0.42%); satisfaction with electronic shift handover increased significantly; there was a reduction in nursing turnover (14.9% vs. 16%); patient satisfaction increased significantly (3.46 vs. 3.34). Introduction of NIS improved patient safety and nursing efficiency and increased nurse and patient satisfaction. Medical organizations must continually improve the nursing information system if they are to provide patients with high quality service in a competitive environment.

  4. Applying lessons from social psychology to transform the culture of error disclosure.

    Science.gov (United States)

    Han, Jason; LaMarra, Denise; Vapiwala, Neha

    2017-10-01

    The ability to carry out prompt and effective error disclosure has been described in the literature as an essential skill among physicians that can lead to improved patient satisfaction, staff well-being and hospital outcomes. However, few studies have addressed the social psychology principles that may influence physician behaviour. The authors provide an overview of recent administrative measures designed to encourage physicians to disclose error, but note that deliberate practice, buttressed with lessons from social psychology, is needed to implement further productive behavioural changes. Two main cognitive biases that may hinder error disclosure are identified, namely: fundamental attribution error, and forecasting error. Strategies to overcome these maladaptive cognitive patterns are discussed. The authors note that interactions with standardised patients (SPs) can be used to simulate hospital encounters and help teach important behavioural considerations. Virtual reality is introduced as an immersive, realistic and easily scalable technology that can supplement traditional curricula. Lastly, the authors highlight the importance of establishing a professional standard of competence, potentially by incorporating difficult patient encounters, including disclosure of error, into medical licensing examinations that assess clinical skills. Existing curricula that cover physician error disclosure may benefit from reviewing the social psychology literature. These lessons, incorporated into SP programmes and emerging technological platforms, may improve training and evaluative methods for all medical trainees. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

  5. Virtual Patient Technology: Engaging Primary Care in Quality Improvement Innovations.

    Science.gov (United States)

    Blok, Amanda C; May, Christine N; Sadasivam, Rajani S; Houston, Thomas K

    2017-02-15

    Engaging health care staff in new quality improvement programs is challenging. We developed 2 virtual patient (VP) avatars in the context of a clinic-level quality improvement program. We sought to determine differences in preferences for VPs and the perceived influence of interacting with the VP on clinical staff engagement with the quality improvement program. Using a participatory design approach, we developed an older male smoker VP and a younger female smoker VP. The older male smoker was described as a patient with cardiovascular disease and was ethnically ambiguous. The female patient was younger and was worried about the impact of smoking on her pregnancy. Clinical staff were allowed to choose the VP they preferred, and the more they engaged with the VP, the more likely the VP was to quit smoking and become healthier. We deployed the VP within the context of a quality improvement program designed to encourage clinical staff to refer their patients who smoke to a patient-centered Web-assisted tobacco intervention. To evaluate the VPs, we used quantitative analyses using multivariate models of provider and practice characteristics and VP characteristic preference and analyses of a brief survey of positive deviants (clinical staff in practices with high rates of encouraging patients to use the quit smoking innovation). A total of 146 clinical staff from 76 primary care practices interacted with the VPs. Clinic staff included medical providers (35/146, 24.0%), nurse professionals (19/146, 13.0%), primary care technicians (5/146, 3.4%), managerial staff (67/146, 45.9%), and receptionists (20/146, 13.7%). Medical staff were mostly male, and other roles were mostly female. Medical providers (OR 0.031; CI 0.003-0.281; P=.002) and younger staff (OR 0.411; CI 0.177-0.952; P=.038) were less likely to choose the younger, female VP when controlling for all other characteristics. VP preference did not influence online patient referrals by staff. In high

  6. Technology advances in hospital practices: robotics in treatment of patients.

    Science.gov (United States)

    Rosiek, Anna; Leksowski, Krzysztof

    2015-06-01

    Laparoscopic cholecystectomy is widely considered as the treatment of choice for acute cholecystitis. The safety of the procedure and its minimal invasiveness made it a valid treatment option for a patient not responding to antibiotic therapy. Our research shows that patients positively assess this treatment method, but the world's tendency is to turn to a more sophisticated method utilizing robot-assisted surgery as a gold standard. Providing patient with minimally invasive surgical procedures that utilize the state-of-the-art equipment like the da Vinci Robotic Surgical System underscores the commitment to high-quality patient care while enhancing patient safety. The advantages include minimal invasive scarring, less pain and bleeding, faster recovery time, and shorter hospital stay. The move toward less invasive and less morbid procedures and a need to re-create the true open surgical experience have paved the way for the development and application of robotic and computer-assisted systems in surgery in Poland as well as the rest of the world. © The Author(s) 2014.

  7. Identification of factors associated with diagnostic error in primary care

    Science.gov (United States)

    2014-01-01

    Background Missed, delayed or incorrect diagnoses are considered to be diagnostic errors. The aim of this paper is to describe the methodology of a study to analyse cognitive aspects of the process by which primary care (PC) physicians diagnose dyspnoea. It examines the possible links between the use of heuristics, suboptimal cognitive acts and diagnostic errors, using Reason’s taxonomy of human error (slips, lapses, mistakes and violations). The influence of situational factors (professional experience, perceived overwork and fatigue) is also analysed. Methods Cohort study of new episodes of dyspnoea in patients receiving care from family physicians and residents at PC centres in Granada (Spain). With an initial expected diagnostic error rate of 20%, and a sampling error of 3%, 384 episodes of dyspnoea are calculated to be required. In addition to filling out the electronic medical record of the patients attended, each physician fills out 2 specially designed questionnaires about the diagnostic process performed in each case of dyspnoea. The first questionnaire includes questions on the physician’s initial diagnostic impression, the 3 most likely diagnoses (in order of likelihood), and the diagnosis reached after the initial medical history and physical examination. It also includes items on the physicians’ perceived overwork and fatigue during patient care. The second questionnaire records the confirmed diagnosis once it is reached. The complete diagnostic process is peer-reviewed to identify and classify the diagnostic errors. The possible use of heuristics of representativeness, availability, and anchoring and adjustment in each diagnostic process is also analysed. Each audit is reviewed with the physician responsible for the diagnostic process. Finally, logistic regression models are used to determine if there are differences in the diagnostic error variables based on the heuristics identified. Discussion This work sets out a new approach to studying the

  8. Identification of factors associated with diagnostic error in primary care.

    Science.gov (United States)

    Minué, Sergio; Bermúdez-Tamayo, Clara; Fernández, Alberto; Martín-Martín, José Jesús; Benítez, Vivian; Melguizo, Miguel; Caro, Araceli; Orgaz, María José; Prados, Miguel Angel; Díaz, José Enrique; Montoro, Rafael

    2014-05-12

    Missed, delayed or incorrect diagnoses are considered to be diagnostic errors. The aim of this paper is to describe the methodology of a study to analyse cognitive aspects of the process by which primary care (PC) physicians diagnose dyspnoea. It examines the possible links between the use of heuristics, suboptimal cognitive acts and diagnostic errors, using Reason's taxonomy of human error (slips, lapses, mistakes and violations). The influence of situational factors (professional experience, perceived overwork and fatigue) is also analysed. Cohort study of new episodes of dyspnoea in patients receiving care from family physicians and residents at PC centres in Granada (Spain). With an initial expected diagnostic error rate of 20%, and a sampling error of 3%, 384 episodes of dyspnoea are calculated to be required. In addition to filling out the electronic medical record of the patients attended, each physician fills out 2 specially designed questionnaires about the diagnostic process performed in each case of dyspnoea. The first questionnaire includes questions on the physician's initial diagnostic impression, the 3 most likely diagnoses (in order of likelihood), and the diagnosis reached after the initial medical history and physical examination. It also includes items on the physicians' perceived overwork and fatigue during patient care. The second questionnaire records the confirmed diagnosis once it is reached. The complete diagnostic process is peer-reviewed to identify and classify the diagnostic errors. The possible use of heuristics of representativeness, availability, and anchoring and adjustment in each diagnostic process is also analysed. Each audit is reviewed with the physician responsible for the diagnostic process. Finally, logistic regression models are used to determine if there are differences in the diagnostic error variables based on the heuristics identified. This work sets out a new approach to studying the diagnostic decision-making process

  9. Eliminating US hospital medical errors.

    Science.gov (United States)

    Kumar, Sameer; Steinebach, Marc

    2008-01-01

    Healthcare costs in the USA have continued to rise steadily since the 1980s. Medical errors are one of the major causes of deaths and injuries of thousands of patients every year, contributing to soaring healthcare costs. The purpose of this study is to examine what has been done to deal with the medical-error problem in the last two decades and present a closed-loop mistake-proof operation system for surgery processes that would likely eliminate preventable medical errors. The design method used is a combination of creating a service blueprint, implementing the six sigma DMAIC cycle, developing cause-and-effect diagrams as well as devising poka-yokes in order to develop a robust surgery operation process for a typical US hospital. In the improve phase of the six sigma DMAIC cycle, a number of poka-yoke techniques are introduced to prevent typical medical errors (identified through cause-and-effect diagrams) that may occur in surgery operation processes in US hospitals. It is the authors' assertion that implementing the new service blueprint along with the poka-yokes, will likely result in the current medical error rate to significantly improve to the six-sigma level. Additionally, designing as many redundancies as possible in the delivery of care will help reduce medical errors. Primary healthcare providers should strongly consider investing in adequate doctor and nurse staffing, and improving their education related to the quality of service delivery to minimize clinical errors. This will lead to an increase in higher fixed costs, especially in the shorter time frame. This paper focuses additional attention needed to make a sound technical and business case for implementing six sigma tools to eliminate medical errors that will enable hospital managers to increase their hospital's profitability in the long run and also ensure patient safety.

  10. How could the topic patient safety be embedded in the curriculum? A recommendation by the Committee for Patient Safety and Error Management of the GMA.

    Science.gov (United States)

    Kiesewetter, Jan; Drossard, Sabine; Gaupp, Rainer; Baschnegger, Heiko; Kiesewetter, Isabel; Hoffmann, Susanne

    2018-01-01

    The topic of patient safety is of fundamental interest for the health care sector. In view of the realisation of the National Competence-Based Learning Objectives Catalogue for Undergraduate Medical Education (NKLM) this topic now has to be prepared for medical education. For a disciplinary and content-related orientation the GMA Committee developed the Learning Objectives Catalogue Patient Safety for Undergraduate Medical Education (GMA-LZK). To ensure an optimal implementation of the GMA-LZK we recommend a longitudinal embedding into the existing curriculum. This position paper supports the implementation of the GMA-LZK and is aimed at everyone who wants to establish teaching courses on the topic patient safety and embed them in the curriculum. In light of this, we will initially describe the key features for a structured analysis of the current situation. Based on three best-practice-examples, as seen in the faculties of Freiburg, Bonn and Munich, different approaches to the implementation of the GMA-LZK will be illustrated. Lastly, we will outline the methodical requirements regarding the curriculum development as well as the disciplinary and methodical competences that the lecturers will have to hold or develop to fulfil the requirements.

  11. Poster COHERENT EFFORT FOR COPD PATIENTS  WITH A SPECIAL FOCUS ON WELFARE TECHNOLOGY

    DEFF Research Database (Denmark)

    Vestergaard*, Kitt; Bagger, Bettan; Bech, Lone

    and consistency of treatment programs for patients with COPD this project seeks to explore: Experiences among patients with COPD and health professionals of implementation of technology regarding own competences for using the technologies as well as its impact on the quality of care. Method: The study...... the brochures as especially good, one expressed "The brochures are really good, that's for sure. I use it in my work with our patients, "and" it was a very good knowledge boost “. They were as well very satisfied about the telephone consultation, "Telephone consultation with a single patient case, which...... was a bit difficult (...)I got really good help." The healthcare professionals who had used www.helbredsprofilen.dk found it very informative and useful, both for them selves as professionals, but also for the patients with COPD. They found that it provide something, that the other technologies don´t, “It...

  12. COHERENT EFFORT FOR COPD PATIENTS  WITH A SPECIAL FOCUS ON WELFARE TECHNOLOGY

    DEFF Research Database (Denmark)

    Vestergaard*, Kitt; Bagger, Bettan; Jensen, Lars Heegaard

    and consistency of treatment programs for patients with COPD this project seeks to explore: Experiences among patients with COPD and health professionals of implementation of technology regarding own competences for using the technologies as well as its impact on the quality of care. Method: The study...... the brochures as especially good, one expressed "The brochures are really good, that's for sure. I use it in my work with our patients, "and" it was a very good knowledge boost “. They were as well very satisfied about the telephone consultation, "Telephone consultation with a single patient case, which...... was a bit difficult (...)I got really good help." The healthcare professionals who had used www.helbredsprofilen.dk found it very informative and useful, both for them selves as professionals, but also for the patients with COPD. They found that it provide something, that the other technologies don´t, “It...

  13. New technologies in treatment of atrial fibrillation in cardiosurgical patients

    Science.gov (United States)

    Evtushenko, A. V.; Evtushenko, V. V.; Bykov, A. N.; Sergeev, V. S.; Syryamkin, V. I.; Kistenev, Yu. V.; Anfinogenova, Ya. D.; Smyshlyaev, K. A.; Kurlov, I. O.

    2015-11-01

    The article is devoted to the evaluation of the results of clinical application of penetrating radiofrequency ablation techniques on atrial myocardium. Total operated on 241 patients with valvular heart disease and coronary heart disease complicated with atrial fibrillation. All operations were performed under cardiopulmonary bypass and cardioplegia. The main group consists of 141 patients which were operated using penetrating technique radiofrequency exposure. The control group consisted of 100 patients who underwent surgery with the use of "classical" monopolar RF-ablation technique. Both groups were not significantly different on all counts before surgery. Patients with previous heart surgery were excluded during the selection of candidates for the procedure, due to the presence of adhesions in the pericardium, that do not allow good visualization of left atrium, sufficient to perform this procedure. Penetrating technique has significantly higher efficiency compared to the "classic" technique in the early and long-term postoperative periods. In the early postoperative period, its efficiency is 93%, and in the long term is 88%. The efficacy of "classical" monopolar procedure is below: 86% and 68% respectively.

  14. Soft errors in modern electronic systems

    CERN Document Server

    Nicolaidis, Michael

    2010-01-01

    This book provides a comprehensive presentation of the most advanced research results and technological developments enabling understanding, qualifying and mitigating the soft errors effect in advanced electronics, including the fundamental physical mechanisms of radiation induced soft errors, the various steps that lead to a system failure, the modelling and simulation of soft error at various levels (including physical, electrical, netlist, event driven, RTL, and system level modelling and simulation), hardware fault injection, accelerated radiation testing and natural environment testing, s

  15. Validation and Assessment of a Technology Familiarity Score in Patients Attending a Symptomatic Breast Clinic.

    Science.gov (United States)

    O'Brien, C; Kelly, J; Lehane, E A; Livingstone, V; Cotter, B; Butt, A; Kelly, L; Corrigan, M A

    2015-10-01

    New media technologies (computers, mobile phones and the internet) have the potential to transform the healthcare information needs of patients with breast disease (Ferlay et al. in Eur J Cancer 49:1374-1403, 2013). However, patients' current level of use and their willingness to accept new media for education and communication remain unknown. This was a single-centre clinic-based prospective cross-sectional study. A previously developed instrument was modified, validated and tested on patients attending a symptomatic breast clinic. The instrument was evaluated on 200 symptomatic breast patients. The commonest outlets for education were staff (95 %), leaflets (69 %) and websites (59 %). Websites are more likely to be consulted by younger patients (higher education were more likely to favour apps, websites and email (p technology use among breast patients is expanding as expected along generational trends. As such its' further integration into healthcare systems can potentially ameliorate patient education and communication.

  16. Avaliação antropométrica de pacientes com suspeita de erros inatos do metabolismo Anthropometric evaluation of patients with suspected innate errors of metabolism

    Directory of Open Access Journals (Sweden)

    Francilia de Kássia Brito-Silva

    2012-09-01

    Full Text Available OBJETIVOS: avaliar antropometricamente os pacientes com suspeita de erros inatos do metabolismo (EIM e descrever a prevalência de distúrbios nutricionais (desnutrição, sobrepeso e obesidade. MÉTODOS: foram avaliados 55 pacientes de 0 a 10 anos, de acordo com os índices antropométricos (A/I, P/I E P/A e IMC/I, no laboratório de erros inatos do metabolismo (LEIM da Universidade Federal do Pará, através de balança e antropômetro. Os dados foram coletados a partir da ficha de atendimento do LEIM. Para o diagnóstico nutricional foram utilizados os programas Anthro e Anthro Plus e o programa SPSS para a análise estatística. RESULTADOS: os pacientes atendidos pertenciam, na maioria, a faixa etária de sete meses a nove anos. Os principais sintomas foram atraso no desenvolvimento neuropsicomotor e infecções frequentes. Quanto ao estado nutricional, foi observado déficit de 23,7% no indicador de peso para idade, déficit de 50,9% no indicador de altura para idade, excesso de peso e obesidade de 15,4% para peso para altura, e 25,1% para índice de massa corporal para idade. CONCLUSÕES: os pacientes apresentaram estado nutricional inadequados, o qual na ausência de diagnóstico de EIM, os fatores envolvidos devem ser mais bem averiguados.OBJECTIVES: to provide an anthropometric evaluation of patients suspected of having innate errors of metabolism (IEMs and report the prevalence of nutritional disorders (malnutrition, overweight and obesity. METHODS: fifty-five patients aged between 0 and 10 years were evaluated for anthropometric indices (H/A, W/A and W/H and BMI/A, in the innate errors of metabolism laboratory (LEIM of the Federal University of Pará, using scales and an anthropometer. The data were collected using an LEIM form. Nutritional diagnosis was carried out using the Anthro and Anthro Plus programs and the SPSS statistics package. RESULTS: the patients attended were mostly aged between seven months and nine years. The main

  17. Purchasing medical innovation the right technology, for the right patient, at the right price

    CERN Document Server

    Robinson, James C

    2015-01-01

    Innovation in medical technology generates a remarkable supply of new drugs, devices, and diagnostics that improve health, reduce risks, and extend life. But these technologies are too often used on the wrong patient, in the wrong setting, or at an unaffordable price. The only way to moderate the growth in health care costs without undermining the dynamic of medical innovation is to improve the process of assessing, pricing, prescribing, and using new technologies. Purchasing Medical Innovation analyzes the contemporary revolution in the purchasing of health care technology, with a focus on th

  18. Outcomes management of mechanically ventilated patients: utilizing informatics technology.

    Science.gov (United States)

    Smith, K R

    1998-11-01

    This article examines an informatics system developed for outcomes management of the mechanically ventilated adult population, focusing on weaning the patient from mechanical ventilation. The link between medical informatics and outcomes management is discussed, along with the development of methods, tools, and data sets for outcomes management of the mechanically ventilated adult population at an acute care academic institution. Pros and cons of this system are identified, and specific areas for improvement of future health care outcomes medical informatics systems are discussed.

  19. Technologies in the patient-centered medical home: examining the model from an enterprise perspective.

    Science.gov (United States)

    Hughes, Cortney L; Marshall, Capt Robert; Murphy, Edward; Mun, Seong K

    2011-01-01

    Fee-for-service reimbursement has fragmented the healthcare system. Providers are paid based on the number of services rendered instead of quality, leading to the cost of care rising at a faster rate than its value. One approach to counter this is the Patient-Centered Medical Home (PCMH), a primary care model that emphasizes team-based medicine, a partnership between patients and providers, and expanded access and communication. The transition to PCMH is facilitated by innovative technologies, such as telemedicine for additional services, electronic medical records to document patients' health needs, and online portals for electronic visits and communication between patients and providers. Implementing these technologies involves tremendous investment of funds and time from practices and healthcare organizations. Although PCMH does not require such technologies, they facilitate its success, as care coordination and population management necessitated by the model are difficult to do without. This article argues that there is a paradox in PCMH and technology is at its center. Although PCMH intends to be cost effective by reducing hospital admissions and ER visits through providing better preventative services, it is actually a financial risk due to the very real upfront costs of implementing and sustaining technologies needed to carry out the intent of the PCMH model, which may not be made up immediately, if ever. This article delves into the rationale behind why payers, providers, and patients have adopted PCMH regardless of this risk and in doing so, maps out the roles that innovative technologies play in the conversion to PCMH.

  20. Field error lottery

    Energy Technology Data Exchange (ETDEWEB)

    Elliott, C.J.; McVey, B. (Los Alamos National Lab., NM (USA)); Quimby, D.C. (Spectra Technology, Inc., Bellevue, WA (USA))

    1990-01-01

    The level of field errors in an FEL is an important determinant of its performance. We have computed 3D performance of a large laser subsystem subjected to field errors of various types. These calculations have been guided by simple models such as SWOOP. The technique of choice is utilization of the FELEX free electron laser code that now possesses extensive engineering capabilities. Modeling includes the ability to establish tolerances of various types: fast and slow scale field bowing, field error level, beam position monitor error level, gap errors, defocusing errors, energy slew, displacement and pointing errors. Many effects of these errors on relative gain and relative power extraction are displayed and are the essential elements of determining an error budget. The random errors also depend on the particular random number seed used in the calculation. The simultaneous display of the performance versus error level of cases with multiple seeds illustrates the variations attributable to stochasticity of this model. All these errors are evaluated numerically for comprehensive engineering of the system. In particular, gap errors are found to place requirements beyond mechanical tolerances of {plus minus}25{mu}m, and amelioration of these may occur by a procedure utilizing direct measurement of the magnetic fields at assembly time. 4 refs., 12 figs.

  1. Impact of Gender on Patient Preferences for Technology-Based Behavioral Interventions

    Directory of Open Access Journals (Sweden)

    David J. Kim

    2014-08-01

    Full Text Available Introduction: Technology-based interventions offer an opportunity to address high-risk behaviors in the emergency department (ED. Prior studies suggest behavioral health strategies are more effective when gender differences are considered. However, the role of gender in ED patient preferences for technology-based interventions has not been examined. The objective was to assess whether patient preferences for technology-based interventions varies by gender. Methods: This was a secondary analysis of data from a systematic survey of adult (18 years of age, English-speaking patients in a large urban academic ED. Subjects were randomly selected during a purposive sample of shifts. The iPad survey included questions on access to technology, preferences for receiving health information, and demographics. We defined ‘‘technology-based’’ as web, text message, e-mail, social networking, or DVD; ‘‘non-technology-based’’ was defined as in-person, written materials, or landline. We calculated descriptive statistics and used univariate tests to compare men and women. Gender-stratified multivariable logistic regression models were used to examine associations between other demographic factors (age, race, ethnicity, income and technology-based preferences for information on specific risky behaviors. Results: Of 417 participants, 45.1% were male. There were no significant demographic differences between men and women. Women were more likely to use computers (90.8% versus 81.9%; p¼0.03, Internet (66.8% versus 59.0%; p¼0.03, and social networks (53.3% versus 42.6%; p¼0.01. 89% of men and 90% of women preferred technology-based formats for at least type of health information; interest in technology-based for individual health topics did not vary by gender. Concern about confidentiality was the most common barrier to technology-based use for both genders. Multivariate analysis showed that for smoking, depression, drug/alcohol use, and injury

  2. Medical Error and Moral Luck.

    Science.gov (United States)

    Hubbeling, Dieneke

    2016-09-01

    This paper addresses the concept of moral luck. Moral luck is discussed in the context of medical error, especially an error of omission that occurs frequently, but only rarely has adverse consequences. As an example, a failure to compare the label on a syringe with the drug chart results in the wrong medication being administered and the patient dies. However, this error may have previously occurred many times with no tragic consequences. Discussions on moral luck can highlight conflicting intuitions. Should perpetrators receive a harsher punishment because of an adverse outcome, or should they be dealt with in the same way as colleagues who have acted similarly, but with no adverse effects? An additional element to the discussion, specifically with medical errors, is that according to the evidence currently available, punishing individual practitioners does not seem to be effective in preventing future errors. The following discussion, using relevant philosophical and empirical evidence, posits a possible solution for the moral luck conundrum in the context of medical error: namely, making a distinction between the duty to make amends and assigning blame. Blame should be assigned on the basis of actual behavior, while the duty to make amends is dependent on the outcome.

  3. Trialling computer touch-screen technology to assess psychological distress in patients with gynaecological cancer

    Directory of Open Access Journals (Sweden)

    Georgia Halkett

    2010-12-01

    Full Text Available BackgroundCancer impacts on the psychological well-being of many cancer patients. Appropriate tools can be used to assist health professionals in identifying patient needs and psychological distress. Recent research suggests that touchscreen technology can be used to administer surveys. The aim of this study was to evaluate the use of a touchscreen system in comparison to written questionnaires in a large tertiary hospital in Western Australia (WA.Method Patients who were scheduled to commence treatment for gynaecological cancer participated in this study. Patients were assigned to complete either a written questionnaire or the same survey using the touchscreen technology. Both methods of survey contained the same scales. All participants were asked to complete a follow-up patient satisfaction survey. Semi-structured interviews were conducted with health professionals to elicit views about the implementation of the technology and the available referral pathways. Data was analysed using descriptive statistics and content analysis. ResultsThirty patients completed the touchscreen questionnaires and an equal number completed the survey on paper. Participants who used the touchscreens were not significantly more satisfied than other participants. Four themes were noted in the interviews with health professionals: usability of technology, patients’ acceptance of technology, advantages of psychological screening and the value of the instruments included.ConclusionAlthough previous studies report that computerised assessments are a feasible option for assessing cancer patients’ needs, the data collected in this study demonstrates that the technology was not reliable with significant practical problems. The technology did not serve these patients better than pen and paper.

  4. Prescription Errors in Psychiatry

    African Journals Online (AJOL)

    Arun Kumar Agnihotri

    clinical pharmacists in detecting errors before they have a (sometimes serious) clinical impact should not be underestimated. Research on medication error in mental health care is limited. .... participation in ward rounds and adverse drug.

  5. Characteristics of pediatric chemotherapy medication errors in a national error reporting database.

    Science.gov (United States)

    Rinke, Michael L; Shore, Andrew D; Morlock, Laura; Hicks, Rodney W; Miller, Marlene R

    2007-07-01

    Little is known regarding chemotherapy medication errors in pediatrics despite studies suggesting high rates of overall pediatric medication errors. In this study, the authors examined patterns in pediatric chemotherapy errors. The authors queried the United States Pharmacopeia MEDMARX database, a national, voluntary, Internet-accessible error reporting system, for all error reports from 1999 through 2004 that involved chemotherapy medications and patients aged error reports, 85% reached the patient, and 15.6% required additional patient monitoring or therapeutic intervention. Forty-eight percent of errors originated in the administering phase of medication delivery, and 30% originated in the drug-dispensing phase. Of the 387 medications cited, 39.5% were antimetabolites, 14.0% were alkylating agents, 9.3% were anthracyclines, and 9.3% were topoisomerase inhibitors. The most commonly involved chemotherapeutic agents were methotrexate (15.3%), cytarabine (12.1%), and etoposide (8.3%). The most common error types were improper dose/quantity (22.9% of 327 cited error types), wrong time (22.6%), omission error (14.1%), and wrong administration technique/wrong route (12.2%). The most common error causes were performance deficit (41.3% of 547 cited error causes), equipment and medication delivery devices (12.4%), communication (8.8%), knowledge deficit (6.8%), and written order errors (5.5%). Four of the 5 most serious errors occurred at community hospitals. Pediatric chemotherapy errors often reached the patient, potentially were harmful, and differed in quality between outpatient and inpatient areas. This study indicated which chemotherapeutic agents most often were involved in errors and that administering errors were common. Investigation is needed regarding targeted medication administration safeguards for these high-risk medications. Copyright (c) 2007 American Cancer Society.

  6. Medication errors in pediatric inpatients

    DEFF Research Database (Denmark)

    Rishoej, Rikke Mie; Almarsdóttir, Anna Birna; Christesen, Henrik Thybo

    2017-01-01

    The aim was to describe medication errors (MEs) in hospitalized children reported to the national mandatory reporting and learning system, the Danish Patient Safety Database (DPSD). MEs were extracted from DPSD from the 5-year period of 2010–2014. We included reports from public hospitals on pati...... safety in pediatric inpatients.(Table presented.)...

  7. Evolving provider payment models and patient access to innovative medical technology.

    Science.gov (United States)

    Long, Genia; Mortimer, Richard; Sanzenbacher, Geoffrey

    2014-12-01

    Abstract Objective: To investigate the evolving use and expected impact of pay-for-performance (P4P) and risk-based provider reimbursement on patient access to innovative medical technology. Structured interviews with leading private payers representing over 110 million commercially-insured lives exploring current and planned use of P4P provider payment models, evidence requirements for technology assessment and new technology coverage, and the evolving relationship between the two topics. Respondents reported rapid increases in the use of P4P and risk-sharing programs, with roughly half of commercial lives affected 3 years ago, just under two-thirds today, and an expected three-quarters in 3 years. All reported well-established systems for evaluating new technology coverage. Five of nine reported becoming more selective in the past 3 years in approving new technologies; four anticipated that in the next 3 years there will be a higher evidence requirement for new technology access. Similarly, four expected it will become more difficult for clinically appropriate but costly technologies to gain coverage. All reported planning to rely more on these types of provider payment incentives to control costs, but didn't see them as a substitute for payer technology reviews and coverage limitations; they each have a role to play. Interviews limited to nine leading payers with models in place; self-reported data. Likely implications include a more uncertain payment environment for providers, and indirectly for innovative medical technology and future investment, greater reliance on quality and financial metrics, and increased evidence requirements for favorable coverage and utilization decisions. Increasing provider financial risk may challenge the traditional technology adoption paradigm, where payers assumed a 'gatekeeping' role and providers a countervailing patient advocacy role with regard to access to new technology. Increased provider financial risk may result in an

  8. Using Technology, Clinical Workflow Redesign, and Team Solutions to Achieve the Patient Centered Medical Home

    Science.gov (United States)

    2011-01-01

    Redesign, and Team Solutions to Achieve the Patient Centered Medical Home LTC Nicole Kerkenbush, MHA, MN Army Medical Department, Office of the...TITLE AND SUBTITLE Using Technology, Clinical Workflow Redesign, and Team Solutions to Achieve the Patient Centered Medical Home 5a. CONTRACT...Describe how these tools are being used to implement the Patient Centered Medical Home care model 2 2011 MHS Conference MEDCOM AHLTA Provider Satisfaction

  9. Error budget calculations in laboratory medicine: linking the concepts of biological variation and allowable medical errors

    NARCIS (Netherlands)

    Stroobants, A. K.; Goldschmidt, H. M. J.; Plebani, M.

    2003-01-01

    Background: Random, systematic and sporadic errors, which unfortunately are not uncommon in laboratory medicine, can have a considerable impact on the well being of patients. Although somewhat difficult to attain, our main goal should be to prevent all possible errors. A good insight on error-prone

  10. [The contribution of Web 2.0 technologies to the empowerment of active patients].

    Science.gov (United States)

    Oliver-Mora, Martí; Iñiguez-Rueda, Lupicinio

    2017-03-01

    The Spanish health system has recently been marked by the emergence of more active patients who are characterized as being better informed about their disease, having a more participatory attitude, wanting to have a greater influence in making decisions about their health and asserting their rights as patients. Therefore, this article aims to report on how the introduction of Web 2.0 technologies can contribute to the empowering of more active patients. To achieve this, 14 semi-structured interviews were conducted with patients and representatives of patient associations who have used Web 2.0 technologies to interact with other patients or to communicate with health professionals. From the results obtained, we highlight the fact that Web 2.0 technologies provide greater access to health-related information, improve communication between patients and health professionals, and enable the creation of new spaces of interaction among patients. All of the facts above contribute to the formation of a more active role on the part of patients.

  11. Analysis of error patterns in clinical radiotherapy

    International Nuclear Information System (INIS)

    Macklis, Roger; Meier, Tim; Barrett, Patricia; Weinhous, Martin

    1996-01-01

    Purpose: Until very recently, prescription errors and adverse treatment events have rarely been studied or reported systematically in oncology. We wished to understand the spectrum and severity of radiotherapy errors that take place on a day-to-day basis in a high-volume academic practice and to understand the resource needs and quality assurance challenges placed on a department by rapid upswings in contract-based clinical volumes requiring additional operating hours, procedures, and personnel. The goal was to define clinical benchmarks for operating safety and to detect error-prone treatment processes that might function as 'early warning' signs. Methods: A multi-tiered prospective and retrospective system for clinical error detection and classification was developed, with formal analysis of the antecedents and consequences of all deviations from prescribed treatment delivery, no matter how trivial. A department-wide record-and-verify system was operational during this period and was used as one method of treatment verification and error detection. Brachytherapy discrepancies were analyzed separately. Results: During the analysis year, over 2000 patients were treated with over 93,000 individual fields. A total of 59 errors affecting a total of 170 individual treated fields were reported or detected during this period. After review, all of these errors were classified as Level 1 (minor discrepancy with essentially no potential for negative clinical implications). This total treatment delivery error rate (170/93, 332 or 0.18%) is significantly better than corresponding error rates reported for other hospital and oncology treatment services, perhaps reflecting the relatively sophisticated error avoidance and detection procedures used in modern clinical radiation oncology. Error rates were independent of linac model and manufacturer, time of day (normal operating hours versus late evening or early morning) or clinical machine volumes. There was some relationship to

  12. Mobile Technology Use Across Age Groups in Patients Eligible for Cardiac Rehabilitation: Survey Study.

    Science.gov (United States)

    Gallagher, Robyn; Roach, Kellie; Sadler, Leonie; Glinatsis, Helen; Belshaw, Julie; Kirkness, Ann; Zhang, Ling; Gallagher, Patrick; Paull, Glenn; Gao, Yan; Partridge, Stephanie Ruth; Parker, Helen; Neubeck, Lis

    2017-10-24

    Emerging evidence indicates mobile technology-based strategies may improve access to secondary prevention and reduce risk factors in cardiac patients. However, little is known about cardiac patients' use of mobile technology, particularly for health reasons and whether the usage varies across patient demographics. This study aimed to describe cardiac patients' use of mobile technology and to determine variations between age groups after adjusting for education, employment, and confidence with using mobile technology. Cardiac patients eligible for attending cardiac rehabilitation were recruited from 9 hospital and community sites across metropolitan and rural settings in New South Wales, Australia. Participants completed a survey on the use of mobile technology devices, features used, confidence with using mobile technology, willingness and interest in learning, and health-related use. The sample (N=282) had a mean age of 66.5 (standard deviation [SD] 10.6) years, 71.9% (203/282) were male, and 79.0% (223/282) lived in a metropolitan area. The most common diagnoses were percutaneous coronary intervention (33.3%, 94/282) and myocardial infarction (22.7%, 64/282). The majority (91.1%, 257/282) used at least one type of technology device, 70.9% (200/282) used mobile technology (mobile phone/tablet), and 31.9% (90/282) used all types. Technology was used by 54.6% (154/282) for health purposes, most often to access information on health conditions (41.4%, 117/282) and medications (34.8%, 98/282). Age had an important independent association with the use of mobile technology after adjusting for education, employment, and confidence. The youngest group (mobile technology than the oldest (>69 years) age group (odds ratio [OR] 4.45, 95% CI 1.46-13.55), 5 times more likely to use mobile apps (OR 5.00, 95% CI 2.01-12.44), and 3 times more likely to use technology for health-related reasons (OR 3.31, 95% CI 1.34-8.18). Compared with the older group, the middle age group (56

  13. Errors in otology.

    Science.gov (United States)

    Kartush, J M

    1996-11-01

    Practicing medicine successfully requires that errors in diagnosis and treatment be minimized. Malpractice laws encourage litigators to ascribe all medical errors to incompetence and negligence. There are, however, many other causes of unintended outcomes. This article describes common causes of errors and suggests ways to minimize mistakes in otologic practice. Widespread dissemination of knowledge about common errors and their precursors can reduce the incidence of their occurrence. Consequently, laws should be passed to allow for a system of non-punitive, confidential reporting of errors and "near misses" that can be shared by physicians nationwide.

  14. Locating Errors Through Networked Surveillance: A Multimethod Approach to Peer Assessment, Hazard Identification, and Prioritization of Patient Safety Efforts in Cardiac Surgery.

    Science.gov (United States)

    Thompson, David A; Marsteller, Jill A; Pronovost, Peter J; Gurses, Ayse; Lubomski, Lisa H; Goeschel, Christine A; Gosbee, John W; Wahr, Joyce; Martinez, Elizabeth A

    2015-09-01

    The objectives were to develop a scientifically sound and feasible peer-to-peer assessment model that allows health-care organizations to evaluate patient safety in cardiovascular operating rooms and to establish safety priorities for improvement. The locating errors through networked surveillance study was conducted to identify hazards in cardiac surgical care. A multidisciplinary team, composed of organizational sociology, organizational psychology, applied social psychology, clinical medicine, human factors engineering, and health services researchers, conducted the study. We used a transdisciplinary approach, which integrated the theories, concepts, and methods from each discipline, to develop comprehensive research methods. Multiple data collection was involved: focused literature review of cardiac surgery-related adverse events, retrospective analysis of cardiovascular events from a national database in the United Kingdom, and prospective peer assessment at 5 sites, involving survey assessments, structured interviews, direct observations, and contextual inquiries. A nominal group methodology, where one single group acts to problem solve and make decisions was used to review the data and develop a list of the top priority hazards. The top 6 priority hazard themes were as follows: safety culture, teamwork and communication, infection prevention, transitions of care, failure to adhere to practices or policies, and operating room layout and equipment. We integrated the theories and methods of a diverse group of researchers to identify a broad range of hazards and good clinical practices within the cardiovascular surgical operating room. Our findings were the basis for a plan to prioritize improvements in cardiac surgical care. These study methods allowed for the comprehensive assessment of a high-risk clinical setting that may translate to other clinical settings.

  15. Radiation therapy patient education using VERT: combination of technology with human care.

    Science.gov (United States)

    Jimenez, Yobelli A; Lewis, Sarah J

    2018-05-13

    The Virtual Environment for Radiotherapy Training (VERT) system is a recently available tool for radiation therapy education. The majority of research regarding VERT-based education is focused on students, with a growing area of research being VERT's role in patient education. Because large differences in educational requirements exist between students and patients, focused resources and subsequent evaluations are necessary to provide solid justification for the unique benefits and challenges posed by VERT in a patient education context. This commentary article examines VERT's role in patient education, with a focus on salient visual features, VERT's ability to address some of the spatial challenges associated with RT patient education and how to combine technology with human care. © 2018 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.

  16. Using technology to develop and distribute patient education storyboards across a health system.

    Science.gov (United States)

    Kisak, Anne Z; Conrad, Kathryn J

    2004-01-01

    To describe the successful implementation of a centrally designed and managed patient education storyboard project using Microsoft PowerPoint in a large multihospital system and physician-based practice settings. Journal articles, project evaluation, and clinical and educational experience. The use of posters, bulletin boards, and storyboards as educational strategies has been reported widely. Two multidisciplinary committees applied new technology to develop storyboards for patient, family, and general public education. Technology can be used to coordinate centralized development of patient education posters, improving accuracy and content of patient education across a healthcare system while streamlining the development and review process and avoiding duplication of work effort. Storyboards are excellent sources of unit-based current, consistent patient education; reduce duplication of efforts; enhance nursing computer competencies; market nursing expertise; and promote nurse educators.

  17. Sources of medical error in refractive surgery.

    Science.gov (United States)

    Moshirfar, Majid; Simpson, Rachel G; Dave, Sonal B; Christiansen, Steven M; Edmonds, Jason N; Culbertson, William W; Pascucci, Stephen E; Sher, Neal A; Cano, David B; Trattler, William B

    2013-05-01

    To evaluate the causes of laser programming errors in refractive surgery and outcomes in these cases. In this multicenter, retrospective chart review, 22 eyes of 18 patients who had incorrect data entered into the refractive laser computer system at the time of treatment were evaluated. Cases were analyzed to uncover the etiology of these errors, patient follow-up treatments, and final outcomes. The results were used to identify potential methods to avoid similar errors in the future. Every patient experienced compromised uncorrected visual acuity requiring additional intervention, and 7 of 22 eyes (32%) lost corrected distance visual acuity (CDVA) of at least one line. Sixteen patients were suitable candidates for additional surgical correction to address these residual visual symptoms and six were not. Thirteen of 22 eyes (59%) received surgical follow-up treatment; nine eyes were treated with contact lenses. After follow-up treatment, six patients (27%) still had a loss of one line or more of CDVA. Three significant sources of error were identified: errors of cylinder conversion, data entry, and patient identification error. Twenty-seven percent of eyes with laser programming errors ultimately lost one or more lines of CDVA. Patients who underwent surgical revision had better outcomes than those who did not. Many of the mistakes identified were likely avoidable had preventive measures been taken, such as strict adherence to patient verification protocol or rigorous rechecking of treatment parameters. Copyright 2013, SLACK Incorporated.

  18. Continuous glucose monitoring technology for personal use: an educational program that educates and supports the patient.

    Science.gov (United States)

    Evert, Alison; Trence, Dace; Catton, Sarah; Huynh, Peter

    2009-01-01

    The purpose of this article is to describe the development and implementation of an educational program for the initiation of real-time continuous glucose monitoring (CGM) technology for personal use, not 3-day CGMS diagnostic studies. The education program was designed to meet the needs of patients managing their diabetes with either diabetes medications or insulin pump therapy in an outpatient diabetes education center using a team-based approach. Observational research, complemented by literature review, was used to develop an educational program model and teaching strategies. Diabetes educators, endocrinologists, CGM manufacturer clinical specialists, and patients with diabetes were also interviewed for their clinical observations and experience. The program follows a progressive educational model. First, patients learn in-depth about real-time CGM technology by attending a group presensor class that provides detailed information about CGM. This presensor class facilitates self-selection among patients concerning their readiness to use real-time CGM. If the patient decides to proceed with real-time CGM use, CGM initiation is scheduled, using a clinic-centered protocol for both start-up and follow-up. Successful use of real-time CGM involves more than just patient enthusiasm or interest in a new technology. Channeling patient interest into a structured educational setting that includes the benefits and limitations of real-time CGM helps to manage patient expectations.

  19. Technology Use, Preferences, and Capacity in Injured Patients at Risk for Posttraumatic Stress Disorder.

    Science.gov (United States)

    Kelly, Cory M; Van Eaton, Erik G; Russo, Joan E; Kelly, Victoria C; Jurkovich, Gregory J; Darnell, Doyanne A; Whiteside, Lauren K; Wang, Jin; Parker, Lea E; Payne, Thomas H; Mooney, Sean D; Bush, Nigel; Zatzick, Douglas F

    2017-01-01

    This investigation comprehensively assessed the technology use, preferences, and capacity of diverse injured trauma survivors with posttraumatic stress disorder (PTSD) symptoms. A total of 121 patients participating in a randomized clinical trial (RCT) of stepped collaborative care targeting PTSD symptoms were administered baseline one-, three-, and six-month interviews that assessed technology use. Longitudinal data about the instability of patient cell phone ownership and phone numbers were collected from follow-up interviews. PTSD symptoms were also assessed over the course of the six months after injury. Regression analyses explored the associations between cell phone instability and PTSD symptoms. At baseline, 71.9% (n = 87) of patients reported current cell phone ownership, and over half (58.2%, n = 46) of these patients possessed basic cell phones. Only 19.0% (n = 23) of patients had no change in cell phone number or physical phone over the course of the six months postinjury. In regression models that adjusted for relevant clinical and demographic characteristics, cell phone instability was associated with higher six-month postinjury PTSD symptom levels (p risk for the development of PTSD have unique technology use patterns, including high rates of cell phone instability. These observations should be strongly considered when developing technology-supported interventions for injured patients with PTSD.

  20. Unmet Communication and Information Needs for Patients with IBD: Implications for Mobile Health Technology.

    Science.gov (United States)

    Khan, Sameer; Dasrath, Florence; Farghaly, Sara; Otobo, Emamuzo; Riaz, Muhammad Safwan; Rogers, Jason; Castillo, Anabella; Atreja, Ashish

    2016-01-01

    In order to develop an application that addresses the most significant challenges facing IBD patients, this qualitative study explored the major hurdles of living with IBD, the information needs of IBD patients, and how application technology may be used to improve quality of life. 15 IBD patients participated in two focus groups of 120 minutes each. Data collection was achieved by combining focus groups with surveys and direct observation of patients looking at a patient-engaged app (HealthPROMISE) screenshots. The survey elicited information on demographics, health literacy and quality of life through the Short IBD Questionnaire (SIBDQ). The needs of IBD patients center around communication as it relates to both patient information needs and navigating the social impacts of IBD on patients' lives: Communication Challenges regarding Information Needs: Patients cited a doctor-patient communication divide where there is a continued lack of goal setting when discussing treatments and a lack of objectivity in disease control. When objectively compared with the SIBDQ, nearly half of the patients in the focus groups wrongly estimated their IBD control.Communication Challenges regarding Social Impacts of IBD: Patients strongly felt that while IBD disrupts routines, adds significant stress, and contributes to a sense of isolation, the impact of these issues would be significantly alleviated through more conversation and better support.Implication for Mobile Health Solutions: Patients want a tool that improves tracking of symptoms, medication adherence and provides education. Physician feedback to patient input on an application is required for long-term sustainability. IBD patients need mobile health technologies that evaluate disease control and the goals of care. Patients feel an objective assessment of their disease control, goal setting and physician feedback will greatly enhance utilization of all mobile health applications.

  1. SU-G-BRC-15: The Potential Clinical Significance of Dose Mapping Error for Intra- Fraction Dose Mapping for Lung Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    Sayah, N [Thomas Cancer Center, Richmond, VA (United States); Weiss, E [Virginia Commonwealth University, Richmond, Virginia (United States); Watkins, W [University of Virginia, Charlottesville, VA (United States); Siebers, J [University of Virginia Health System, Charlottesville, VA (United States)

    2016-06-15

    Purpose: To evaluate the dose-mapping error (DME) inherent to conventional dose-mapping algorithms as a function of dose-matrix resolution. Methods: As DME has been reported to be greatest where dose-gradients overlap tissue-density gradients, non-clinical 66 Gy IMRT plans were generated for 11 lung patients with the target edge defined as the maximum 3D density gradient on the 0% (end of inhale) breathing phase. Post-optimization, Beams were copied to 9 breathing phases. Monte Carlo dose computed (with 2*2*2 mm{sup 3} resolution) on all 10 breathing phases was deformably mapped to phase 0% using the Monte Carlo energy-transfer method with congruent mass-mapping (EMCM); an externally implemented tri-linear interpolation method with voxel sub-division; Pinnacle’s internal (tri-linear) method; and a post-processing energy-mass voxel-warping method (dTransform). All methods used the same base displacement-vector-field (or it’s pseudo-inverse as appropriate) for the dose mapping. Mapping was also performed at 4*4*4 mm{sup 3} by merging adjacent dose voxels. Results: Using EMCM as the reference standard, no clinically significant (>1 Gy) DMEs were found for the mean lung dose (MLD), lung V20Gy, or esophagus dose-volume indices, although MLD and V20Gy were statistically different (2*2*2 mm{sup 3}). Pinnacle-to-EMCM target D98% DMEs of 4.4 and 1.2 Gy were observed ( 2*2*2 mm{sup 3}). However dTransform, which like EMCM conserves integral dose, had DME >1 Gy for one case. The root mean square RMS of the DME for the tri-linear-to- EMCM methods was lower for the smaller voxel volume for the tumor 4D-D98%, lung V20Gy, and cord D1%. Conclusion: When tissue gradients overlap with dose gradients, organs-at-risk DME was statistically significant but not clinically significant. Target-D98%-DME was deemed clinically significant for 2/11 patients (2*2*2 mm{sup 3}). Since tri-linear RMS-DME between EMCM and tri-linear was reduced at 2*2*2 mm{sup 3}, use of this resolution is

  2. The Technology-Enabled Patient Advocate: A Valuable Emerging Healthcare Partner.

    Science.gov (United States)

    Kent, Susan M; Yellowlees, Peter

    2015-12-01

    The U.S. healthcare system is changing and is becoming more patient-centered and technology-supported, with greater emphasis on population health outcomes and team-based care. The roles of healthcare providers are changing, and new healthcare roles are developing such as that of the patient advocate. This article reviews the history of this type of role, the changes that have taken place over time, the technological innovations in service delivery that further enable the role, and how the role could increasingly be developed in the future. Logical future extensions of the current typical patient advocate are the appearance of a virtual or avatar-driven care navigator, using telemedicine and related information technologies, as healthcare provision moves increasingly in a hybrid direction, with care being given both in-person and online.

  3. Patient Outcomes as Transformative Mechanisms to Bring Health Information Technology Industry and Research Informatics Closer Together.

    Science.gov (United States)

    Krive, Jacob

    2015-01-01

    Despite the fast pace of recent innovation within the health information technology and research informatics domains, there remains a large gap between research and academia, while interest in translating research innovations into implementations in the patient care settings is lacking. This is due to absence of common outcomes and performance measurement targets, with health information technology industry employing financial and operational measures and academia focusing on patient outcome concerns. The paper introduces methodology for and roadmap to introduction of common objectives as a way to encourage better collaboration between industry and academia using patient outcomes as a composite measure of demonstrated success from health information systems investments. Along the way, the concept of economics of health informatics, or "infonomics," is introduced to define a new way of mapping future technology investments in accordance with projected clinical impact.

  4. How Can Health Information Technologies Contribute to Improve Health Care Services for High-Need Patients?

    Science.gov (United States)

    Nøhr, Christian; Botin, Lars; Zhu, Xinxin

    2017-01-01

    This paper discusses how health information technologies like tele-care, tele-health and tele-medicine can improve the condition for high-need patients, specifically in relation to access. The paper addresses specifically the values of timeliness and equity and how tele technological solutions can support and enhance these values. The paper introduces to the concept of scaffolding, which constitutes the framework for dynamic, appropriate, caring and embracing approaches for engaging and involving high-need patients that are vulnerable and exposed. A number of specific considerations for designing tele-technologies for high-need patients are derived, and the paper concludes that ethical and epistemological criterions for design are needed in order to meet the needs and requirements of the weak and exposed.

  5. Hospital based patient coordination for ethnic minority patients - a health technology assessment

    DEFF Research Database (Denmark)

    Sodemann, Morten

    A cross diciplinary, cross specialty, cross sectoral hospital based approach to cultural management of ethnic minority patients is effective in creating more approprite patient flows, better quality of care and increases functional level of patients. Surprisingly the aggregated effect saves...... especially on public medicine expenses and social services. Ethnic minority patients can achieve increased empowerment & Equity in type and quality of hospital care through cross dicplinary cross specialty cultural case management & support between hospital departments and primary sectors...

  6. Development of the PRE-HIT instrument: patient readiness to engage in health information technology.

    Science.gov (United States)

    Koopman, Richelle J; Petroski, Gregory F; Canfield, Shannon M; Stuppy, Julie A; Mehr, David R

    2014-01-28

    Technology-based aids for lifestyle change are becoming more prevalent for chronic conditions. Important "digital divides" remain, as well as concerns about privacy, data security, and lack of motivation. Researchers need a way to characterize participants' readiness to use health technologies. To address this need, we created an instrument to measure patient readiness to engage with health technologies among adult patients with chronic conditions. Initial focus groups to determine domains, followed by item development and refinement, and exploratory factor analysis to determine final items and factor structure. The development sample included 200 patients with chronic conditions from 6 family medicine clinics. From 98 potential items, 53 best candidate items were examined using exploratory factor analysis. Pearson's Correlation for Test/Retest reliability at 3 months. The final instrument had 28 items that sorted into 8 factors with associated Cronbach's alpha: 1) Health Information Need (0.84), 2) Computer/Internet Experience (0.87), 3) Computer Anxiety (0.82), 4) Preferred Mode of Interaction (0.73), 5) Relationship with Doctor (0.65), 6) Cell Phone Expertise (0.75), 7) Internet Privacy (0.71), and 8) No News is Good News (0.57). Test-retest reliability for the 8 subscales ranged from (0.60 to 0.85). The Patient Readiness to Engage in Health Internet Technology (PRE-HIT) instrument has good psychometric properties and will be an aid to researchers investigating technology-based health interventions. Future work will examine predictive validity.

  7. [Analysis of medical cost of atlantoaxial disorders in patients receiving innovated treatment technologies].

    Science.gov (United States)

    Wu, Yunxia; Liu, Zhongjun

    2016-01-19

    To explore the effects of innovated technologies and products on improving outcomes and decreasing medical costs by analyzing a total and subtotal medical costs of patients with atlantoaxial disorders. The medical costs of 1 489 patients with atlantoaxial disorders from Peking University Third Hospital from 2005 to 2014, who received innovated technologies and products treatment were retrospectively analyzed and compared.Descriptive analysis and ANOVA were used for statistical analysis, and SPSS 19.0 was used to analyze data. From 2005 to 2014, under the situation of a general increase in medical cost by 327%, the total medical costs were stable for patients who used innovated technologies and products for treatment, fluctuating from 20 851 in 2005 to 20 878 in 2014; however, the cases of operation increased year by year, from 88 in 2005 to 163 in 2014; the average length of stay decreased from 21 in 2005 to 10 in 2014; the total cases of transfusion were 22 from 2005 to 2014; the safety, stability and feasibility of the innovated technologies and products were illustrated through the decrease of average length of stay, the reduction of bleeding and the significance of outcomes. It is illustrated that the innovated technologies and products not only decrease patients' suffering and medical costs but also are safe, stable and feasible.

  8. Designing a patient monitoring system for bipolar disorder using Semantic Web technologies.

    Science.gov (United States)

    Thermolia, Chryssa; Bei, Ekaterini S; Petrakis, Euripides G M; Kritsotakis, Vangelis; Tsiknakis, Manolis; Sakkalis, Vangelis

    2015-01-01

    The new movement to personalize treatment plans and improve prediction capabilities is greatly facilitated by intelligent remote patient monitoring and risk prevention. This paper focuses on patients suffering from bipolar disorder, a mental illness characterized by severe mood swings. We exploit the advantages of Semantic Web and Electronic Health Record Technologies to develop a patient monitoring platform to support clinicians. Relying on intelligently filtering of clinical evidence-based information and individual-specific knowledge, we aim to provide recommendations for treatment and monitoring at appropriate time or concluding into alerts for serious shifts in mood and patients' non response to treatment.

  9. Impact of patient-specific factors, irradiated left ventricular volume, and treatment set-up errors on the development of myocardial perfusion defects after radiation therapy for left-sided breast cancer

    International Nuclear Information System (INIS)

    Evans, Elizabeth S.; Prosnitz, Robert G.; Yu Xiaoli; Zhou Sumin; Hollis, Donna R.; Wong, Terence Z.; Light, Kim L.; Hardenbergh, Patricia H.; Blazing, Michael A.; Marks, Lawrence B.

    2006-01-01

    Purpose: The aim of this study was to assess the impact of patient-specific factors, left ventricle (LV) volume, and treatment set-up errors on the rate of perfusion defects 6 to 60 months post-radiation therapy (RT) in patients receiving tangential RT for left-sided breast cancer. Methods and Materials: Between 1998 and 2005, a total of 153 patients were enrolled onto an institutional review board-approved prospective study and had pre- and serial post-RT (6-60 months) cardiac perfusion scans to assess for perfusion defects. Of the patients, 108 had normal pre-RT perfusion scans and available follow-up data. The impact of patient-specific factors on the rate of perfusion defects was assessed at various time points using univariate and multivariate analysis. The impact of set-up errors on the rate of perfusion defects was also analyzed using a one-tailed Fisher's Exact test. Results: Consistent with our prior results, the volume of LV in the RT field was the most significant predictor of perfusion defects on both univariate (p = 0.0005 to 0.0058) and multivariate analysis (p = 0.0026 to 0.0029). Body mass index (BMI) was the only significant patient-specific factor on both univariate (p = 0.0005 to 0.022) and multivariate analysis (p = 0.0091 to 0.05). In patients with very small volumes of LV in the planned RT fields, the rate of perfusion defects was significantly higher when the fields set-up 'too deep' (83% vs. 30%, p = 0.059). The frequency of deep set-up errors was significantly higher among patients with BMI ≥25 kg/m 2 compared with patients of normal weight (47% vs. 28%, p = 0.068). Conclusions: BMI ≥25 kg/m 2 may be a significant risk factor for cardiac toxicity after RT for left-sided breast cancer, possibly because of more frequent deep set-up errors resulting in the inclusion of additional heart in the RT fields. Further study is necessary to better understand the impact of patient-specific factors and set-up errors on the development of RT

  10. Remote patient management: technology-enabled innovation and evolving business models for chronic disease care.

    Science.gov (United States)

    Coye, Molly Joel; Haselkorn, Ateret; DeMello, Steven

    2009-01-01

    Remote patient management (RPM) is a transformative technology that improves chronic care management while reducing net spending for chronic disease. Broadly deployed within the Veterans Health Administration and in many small trials elsewhere, RPM has been shown to support patient self-management, shift responsibilities to non-clinical providers, and reduce the use of emergency department and hospital services. Because transformative technologies offer major opportunities to advance national goals of improved quality and efficiency in health care, it is important to understand their evolution, the experiences of early adopters, and the business models that may support their deployment.

  11. Errors and complications in surgical treatment of non-stable equino-plano-valgus foot deformity in patients with cerebral palsy, with use of the calcaneus correcting osteotomy technique

    Directory of Open Access Journals (Sweden)

    Valery V. Umnov

    2017-03-01

    Full Text Available Aims. To examine the results of treatment for patients with a non-stable form of equino-plano-valgus foot deformity in cerebral palsy with the use of corrective osteotomy of the calcaneus. To further analyze the errors and complications that occurred in patients treated with this technique. Materials and methods. From 2006 to 2014, 64 patients (103 feet aged 3 to 17 years were operated using the described method of calcaneus correcting osteotomy. The equinus contracture was eliminated by transection of the gastrocnemius muscle tendon and extending achilloplastic surgery. The abnormal muscle tone was reduced either by administering the drug Dysport into the gastrocnemius muscle or by selective neurotomy of the tibial nerve. Results. The analysis revealed that there were good results for 75%, satisfactory results for 18%, and unacceptable results for 7% of patients. The unacceptable results of treatment were due to several technical and tactical errors, which were grouped and analyzed. Conclusion. The analysis of errors and complications of calcaneus corrective osteotomy for patients with cerebral palsy with a mobile form of talipes equinoplanovalgus will enable their future avoidance and improvement of the treatment quality.

  12. ERRORS AND COMPLICATIONS IN SURGICAL TREATMENT OF NON-STABLE EQUINO-PLANO-VALGUS FOOT DEFORMITY IN PATIENTS WITH CEREBRAL PALSY, WITH USE OF THE CALCANEUS CORRECTING OSTEOTOMY TECHNIQUE

    Directory of Open Access Journals (Sweden)

    Valery V. Umnov

    2017-03-01

    Full Text Available Aims. To examine the results of treatment for patients with a non-stable form of equino-plano-valgus foot deformity in cerebral palsy with the use of corrective osteotomy of the calcaneus. To further analyze the errors and complications that occurred in patients treated with this technique. Materials and methods. From 2006 to 2014, 64 patients (103 feet aged 3 to 17 years were operated using the described method of calcaneus correcting osteotomy. The equinus contracture was eliminated by transection of the gastrocnemius muscle tendon and extending achilloplastic surgery. The abnormal muscle tone was reduced either by administering the drug Dysport into the gastrocnemius muscle or by selective neurotomy of the tibial nerve. Results. The analysis revealed that there were good results for 75%, satisfactory results for 18%, and unacceptable results for 7% of patients. The unacceptable results of treatment were due to several technical and tactical errors, which were grouped and analyzed. Conclusion. The analysis of errors and complications of calcaneus corrective osteotomy for patients with cerebral palsy with a mobile form of talipes equinoplanovalgus will enable their future avoidance and improvement of the treatment quality.

  13. Medication Errors: New EU Good Practice Guide on Risk Minimisation and Error Prevention.

    Science.gov (United States)

    Goedecke, Thomas; Ord, Kathryn; Newbould, Victoria; Brosch, Sabine; Arlett, Peter

    2016-06-01

    A medication error is an unintended failure in the drug treatment process that leads to, or has the potential to lead to, harm to the patient. Reducing the risk of medication errors is a shared responsibility between patients, healthcare professionals, regulators and the pharmaceutical industry at all levels of healthcare delivery. In 2015, the EU regulatory network released a two-part good practice guide on medication errors to support both the pharmaceutical industry and regulators in the implementation of the changes introduced with the EU pharmacovigilance legislation. These changes included a modification of the 'adverse reaction' definition to include events associated with medication errors, and the requirement for national competent authorities responsible for pharmacovigilance in EU Member States to collaborate and exchange information on medication errors resulting in harm with national patient safety organisations. To facilitate reporting and learning from medication errors, a clear distinction has been made in the guidance between medication errors resulting in adverse reactions, medication errors without harm, intercepted medication errors and potential errors. This distinction is supported by an enhanced MedDRA(®) terminology that allows for coding all stages of the medication use process where the error occurred in addition to any clinical consequences. To better understand the causes and contributing factors, individual case safety reports involving an error should be followed-up with the primary reporter to gather information relevant for the conduct of root cause analysis where this may be appropriate. Such reports should also be summarised in periodic safety update reports and addressed in risk management plans. Any risk minimisation and prevention strategy for medication errors should consider all stages of a medicinal product's life-cycle, particularly the main sources and types of medication errors during product development. This article

  14. Designing Patient-facing Health Information Technologies for the Outpatient Settings: A Literature Review

    Directory of Open Access Journals (Sweden)

    Yushi Yang

    2016-04-01

    Full Text Available Introduction: The implementation of health information technologies (HITs has changed the dynamics of doctor–patient communication in outpatient settings. Designing patient-facing HITs provides patients with easy access to healthcare information during the visit and has the potential to enhance the patient-centred care.   Objectives: The objectives of this study are to systematically review how the designs of patient-facing HITs have been suggested and evaluated, and how they may potentially affect the doctor–patient communication and patient-centred care.   Method: We conducted an online database search to identify articles published before December 2014 relevant to the objectives of this study. A total of nine papers have been identified and reviewed in this study.   Results: Designing patient-facing HITs is at an early stage. The current literature has been exploring the impact of HITs on doctor–patient communication dynamics. Based on the findings of these studies, there is an emergent need to design more patient-centred HITs. There are also some papers that focus on the usability evaluation of some preliminary prototypes of the patient-facing HITs. The design styles of patient-facing HITs included sharing the health information with the patients on: (1 a separate patient display, (2 a projector, (3 a portable tablet, (4 a touch-based screen and (5 a shared computer display that can be viewed by both doctors and patients. Each of them had the strengths and limitations to facilitate the patient-centred care, and it is worthwhile to make a comparison of them in order to identify future research directions.   Conclusion: The designs of patient-facing HITs in outpatient settings are promising in facilitating the doctor-patient communication and patient engagement. However, their effectiveness and usefulness need to be further evaluated and improved from a systems perspective.

  15. Designing Patient-facing Health Information Technologies for the Outpatient Settings: A Literature Review.

    Science.gov (United States)

    Yang, Yushi; Asan, Onur

    2016-04-06

      The implementation of health information technologies (HITs) has changed the dynamics of doctor-patient communication in outpatient settings. Designing patient-facing HITs provides patients with easy access to healthcare information during the visit and has the potential to enhance the patient-centred care.  The objectives of this study are to systematically review how the designs of patient-facing HITs have been suggested and evaluated, and how they may potentially affect the doctor-patient communication and patient-centred care.  We conducted an online database search to identify articles published before December 2014 relevant to the objectives of this study. A total of nine papers have been identified and reviewed in this study.  Designing patient-facing HITs is at an early stage. The current literature has been exploring the impact of HITs on doctor-patient communication dynamics. Based on the findings of these studies, there is an emergent need to design more patient-centred HITs. There are also some papers that focus on the usability evaluation of some preliminary prototypes of the patient-facing HITs. The design styles of patient-facing HITs included sharing the health information with the patients on: (1) a separate patient display, (2) a projector, (3) a portable tablet, (4) a touch-based screen and (5) a shared computer display that can be viewed by both doctors and patients. Each of them had the strengths and limitations to facilitate the patient-centred care, and it is worthwhile to make a comparison of them in order to identify future research directions.  The designs of patient-facing HITs in outpatient settings are promising in facilitating the doctor-patient communication and patient engagement. However, their effectiveness and usefulness need to be further evaluated and improved from a systems perspective.

  16. The error in total error reduction.

    Science.gov (United States)

    Witnauer, James E; Urcelay, Gonzalo P; Miller, Ralph R

    2014-02-01

    Most models of human and animal learning assume that learning is proportional to the discrepancy between a delivered outcome and the outcome predicted by all cues present during that trial (i.e., total error across a stimulus compound). This total error reduction (TER) view has been implemented in connectionist and artificial neural network models to describe the conditions under which weights between units change. Electrophysiological work has revealed that the activity of dopamine neurons is correlated with the total error signal in models of reward learning. Similar neural mechanisms presumably support fear conditioning, human contingency learning, and other types of learning. Using a computational modeling approach, we compared several TER models of associative learning to an alternative model that rejects the TER assumption in favor of local error reduction (LER), which assumes that learning about each cue is proportional to the discrepancy between the delivered outcome and the outcome predicted by that specific cue on that trial. The LER model provided a better fit to the reviewed data than the TER models. Given the superiority of the LER model with the present data sets, acceptance of TER should be tempered. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. Towards safe information technology in health care

    NARCIS (Netherlands)

    J.E.C.M. Aarts (Jos)

    2011-01-01

    textabstractHealth information technology is widely accepted to increase patient safety and reduce medical errors. The widespread implementation makes evident that health information technology has become of a complex sociotechnical system that is health care. Design and implementation may result in

  18. Applying Intelligent Algorithms to Automate the Identification of Error Factors.

    Science.gov (United States)

    Jin, Haizhe; Qu, Qingxing; Munechika, Masahiko; Sano, Masataka; Kajihara, Chisato; Duffy, Vincent G; Chen, Han

    2018-05-03

    Medical errors are the manifestation of the defects occurring in medical processes. Extracting and identifying defects as medical error factors from these processes are an effective approach to prevent medical errors. However, it is a difficult and time-consuming task and requires an analyst with a professional medical background. The issues of identifying a method to extract medical error factors and reduce the extraction difficulty need to be resolved. In this research, a systematic methodology to extract and identify error factors in the medical administration process was proposed. The design of the error report, extraction of the error factors, and identification of the error factors were analyzed. Based on 624 medical error cases across four medical institutes in both Japan and China, 19 error-related items and their levels were extracted. After which, they were closely related to 12 error factors. The relational model between the error-related items and error factors was established based on a genetic algorithm (GA)-back-propagation neural network (BPNN) model. Additionally, compared to GA-BPNN, BPNN, partial least squares regression and support vector regression, GA-BPNN exhibited a higher overall prediction accuracy, being able to promptly identify the error factors from the error-related items. The combination of "error-related items, their different levels, and the GA-BPNN model" was proposed as an error-factor identification technology, which could automatically identify medical error factors.

  19. Information technology to support patient engagement: where do we stand and where can we go?

    Science.gov (United States)

    Walker, Daniel M; Sieck, Cynthia J; Menser, Terri; Huerta, Timothy R; Scheck McAlearney, Ann

    2017-11-01

    Given the strong push to empower patients and make them partners in their health care, we evaluated the current capability of hospitals to offer health information technology that facilitates patient engagement (PE). Using an ontology mapping approach, items from the American Hospital Association Information Technology Supplement were mapped to defined levels and categories within the PE Framework. Points were assigned for each health information technology function based upon the level of engagement it encompassed to create a PE-information technology (PE-IT) score. Scores were divided into tertiles, and hospital characteristics were compared across tertiles. An ordered logit model was used to estimate the effect of characteristics on the adjusted odds of being in the highest tertile of PE-IT scores. Thirty-six functions were mapped to specific levels and categories of the PE Framework, and adoption of each item ranged from 23.5 to 96.7%. Hospital characteristics associated with being in the highest tertile of PE-IT scores included medium and large bed size (relative to small), nonprofit (relative to government nonfederal), teaching hospital, system member, Midwest and South regions, and urban location. Hospital adoption of PE-oriented technology remains varied, suggesting that hospitals are considering how technology can create partnerships with patients. However, PE functionalities that facilitate higher levels of engagement are lacking, suggesting room for improvement. While hospitals have reached modest levels of adoption of PE technologies, consistent monitoring of this capacity can identify opportunities to use technology to facilitate engagement. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  20. Traceability in Patient Healthcare through the Integration of RFID Technology in an ICU in a Hospital.

    Science.gov (United States)

    Martínez Pérez, María; Dafonte, Carlos; Gómez, Ángel

    2018-05-19

    Patient safety is a principal concern for health professionals in the care process and it is, therefore, necessary to provide information management systems to each unit of the hospital, capable of tracking patients and medication to reduce the occurrence of adverse events and therefore increase the quality of care received by patients during their stay in hospital. This work presents a tool for the Intensive Care Unit (ICU), a key service with special characteristics, which computerises and tracks admissions, care plans, vital monitoring, the prescription and medication administration process for patients in this service. To achieve this, it is essential that innovative and cutting-edge technologies are implemented such as Near Field Communication (NFC) technology which is now being implemented in diverse environments bringing a range of benefits to the tasks for which it is employed.

  1. Systematic Procedural Error

    National Research Council Canada - National Science Library

    Byrne, Michael D

    2006-01-01

    .... This problem has received surprisingly little attention from cognitive psychologists. The research summarized here examines such errors in some detail both empirically and through computational cognitive modeling...

  2. Human errors and mistakes

    International Nuclear Information System (INIS)

    Wahlstroem, B.

    1993-01-01

    Human errors have a major contribution to the risks for industrial accidents. Accidents have provided important lesson making it possible to build safer systems. In avoiding human errors it is necessary to adapt the systems to their operators. The complexity of modern industrial systems is however increasing the danger of system accidents. Models of the human operator have been proposed, but the models are not able to give accurate predictions of human performance. Human errors can never be eliminated, but their frequency can be decreased by systematic efforts. The paper gives a brief summary of research in human error and it concludes with suggestions for further work. (orig.)

  3. A Pilot Study to Improve Access to Eye Care Services for Patients in Rural India by Implementing Community Ophthalmology through Innovative Telehealth Technology.

    Science.gov (United States)

    John, Sheila; Premila, M; Javed, Mohd; Vikas, G; Wagholikar, Amol

    2015-01-01

    To inform about a very unique and first of its kind telehealth pilot study in India that has provided virtual telehealth consultation to eye care patients in low resource at remote villages. Provision of Access to eye care services in remote population is always challenging due to pragmatic reasons. Advances in Telehealth technologies have provided an opportunity to improve access to remote population. However, current Telehealth technologies are limited to face-to-face video consultation only. We inform about a pilot study that illustrates real-time imaging access to ophthalmologists. Our innovative software led technology solution allowed screening of patients with varying ocular conditions. Eye camps were conducted in 2 districts in South India over a 12-month period in 2014. Total of 196 eye camps were conducted. Total of 19,634 patients attended the eye camps. Innovative software was used to conduct consultation with the ophthalmologist located in the city hospital. The software enabled virtual visit and allowed instant sharing of fundus camera images for assessment and diagnosis. About 71% of the patients were found to have Refractive Error problems, 15% of them were found to have cataract, 7% of the patients were diagnosed to have Retina problems and 7% of the patients were found to have other ocular diseases. The patients requiring cataract surgery were immediately transferred to city hospital for treatment. Software led assessment of fundus camera images assisted in identifying retinal eye diseases. Our real-time virtual visit software assisted in specialist care provision and illustrated a novel tele health solution for low resource population.

  4. Literacy disparities in patient access and health-related use of Internet and mobile technologies.

    Science.gov (United States)

    Bailey, Stacy C; O'Conor, Rachel; Bojarski, Elizabeth A; Mullen, Rebecca; Patzer, Rachel E; Vicencio, Daniel; Jacobson, Kara L; Parker, Ruth M; Wolf, Michael S

    2015-12-01

    Age and race-related disparities in technology use have been well documented, but less is known about how health literacy influences technology access and use. To assess the association between patients' literacy skills and mobile phone ownership, use of text messaging, Internet access, and use of the Internet for health-related purposes. A secondary analysis utilizing data from 1077 primary care patients enrolled in two, multisite studies from 2011-2013. Patients were administered an in-person, structured interview. Patients with adequate health literacy were more likely to own a mobile phone or smartphone in comparison with patients having marginal or low literacy (mobile phone ownership: 96.8 vs. 95.2 vs. 90.1%, respectively, P Internet from their home (92.1 vs. 74.7 vs. 44.9%, P Internet for email (93.0 vs. 75.7 vs. 38.5%, P technology access and use are widespread, with lower literate patients being less likely to own smartphones or to access and use the Internet, particularly for health reasons. Future interventions should consider these disparities and ensure that health promotion activities do not further exacerbate disparities. © 2014 John Wiley & Sons Ltd.

  5. [Echo-tracking technology for evaluating femoral artery endothelial function in patients with Grave's disease].

    Science.gov (United States)

    Wei, Wei; Wang, Jingyuan; Zhao, Qiaoling; Yang, Jinru

    2012-10-01

    To assess the value of echo-tracking technology in evaluating endothelial function of the femoral artery in patients with Grave's disease. Thirty-four patients with Grave's disease patients and 30 normal adults as controls were recruited in this study. The intima-media thickness (IMT), arterial stiffness (β), pressure strain elastic modulus (Ep), arterial compliance (AC), pulse wave conducting velocity (PWVβ) and augmentation index (AI) parameters were examined using echo-tracking technology for evaluating the right femoral arterial elasticity. Compared with the control subjects, the patients with Grave's disease showed significantly increased β, Ep, and PWVβ and significantly decreased AC (P0.05). In patients with Grave's disease, β and Ep were positively correlated with FT3, FT4, TT3, TT4, and PWVβ was positively correlated with FT3 and FT4. Echo-tracking technology can provide more accurate quantitative evidences for early diagnosis of femoral artery endothelial dysfunction in patients with Grave's disease, but the influence of procedural factors on the measurement accuracy should be considered in the evaluation.

  6. Pressure map technology for pressure ulcer patients: can we handle the truth?

    Science.gov (United States)

    Pompeo, Matthew Q

    2013-02-01

    Objective. The purpose of this study was to trial new pressure mapping technology for patients with pressure ulcers. Pressure mapping data was recorded during 3 phases of technology implementation, as nurses became increasingly familiar with pressuremapping technology in a 55-bed, long-term acute care (LTAC) facility in North Texas. Forty-three patients with pressure ulcers were selected for the study. Patients with pressure ulcers, or who were considered at high risk for developing pressure ulcers based on a Braden score of ≤ 12, were selected to utilize a pressure-sensing device system. Turning timeliness improved greatly from the baseline phase to the last phase. The average turning after the 2-hour alarm decreased from 120 minutes to 44 minutes, and the median time to turning decreased from 39 minutes to 17 minutes. If time past 2 hours is considered the most damaging time to tissue, these reductions (average and median) represented 63% and 56% less potential tissue damage. Pressure mapping technology is in its infancy and this paper discusses implications for the future, including barriers to implementation and potential advanced applications. While only changes in nursing practice were measured in this study, the changes observed suggest the technology can be instrumental in reducing hospital-acquired pressure ulcers and improving the healing of pressure wounds in the future. .

  7. How to minimize perceptual error and maximize expertise in medical imaging

    Science.gov (United States)

    Kundel, Harold L.

    2007-03-01

    Visual perception is such an intimate part of human experience that we assume that it is entirely accurate. Yet, perception accounts for about half of the errors made by radiologists using adequate imaging technology. The true incidence of errors that directly affect patient well being is not known but it is probably at the lower end of the reported values of 3 to 25%. Errors in screening for lung and breast cancer are somewhat better characterized than errors in routine diagnosis. About 25% of cancers actually recorded on the images are missed and cancer is falsely reported in about 5% of normal people. Radiologists must strive to decrease error not only because of the potential impact on patient care but also because substantial variation among observers undermines confidence in the reliability of imaging diagnosis. Observer variation also has a major impact on technology evaluation because the variation between observers is frequently greater than the difference in the technologies being evaluated. This has become particularly important in the evaluation of computer aided diagnosis (CAD). Understanding the basic principles that govern the perception of medical images can provide a rational basis for making recommendations for minimizing perceptual error. It is convenient to organize thinking about perceptual error into five steps. 1) The initial acquisition of the image by the eye-brain (contrast and detail perception). 2) The organization of the retinal image into logical components to produce a literal perception (bottom-up, global, holistic). 3) Conversion of the literal perception into a preferred perception by resolving ambiguities in the literal perception (top-down, simulation, synthesis). 4) Selective visual scanning to acquire details that update the preferred perception. 5) Apply decision criteria to the preferred perception. The five steps are illustrated with examples from radiology with suggestions for minimizing error. The role of perceptual

  8. Electronic game: A key effective technology to promote behavioral change in cancer patients

    Directory of Open Access Journals (Sweden)

    Reza Safdari

    2016-01-01

    Full Text Available Cancer diagnosis is a very unpleasant and unbelievable experience. Appropriate management and treatment of these diseases require a high degree of patient engagement. Interactive health electronic games are engaging, fun, challenging, and experiential and have the potential to change the attitude and behavior, which can improve the player's health. The use of these digital tools, as one of the most attractive and entertaining modern technologies, canem power patients, provide suitable palliative care, promote health behavior change strategies, increase patient engagement, enhance healthy lifestyle habits, improve self.management, and finally improve the quality of life of the patients. Finally, the aim of this article was to describe electronic games and their effects on the promotion of behavior change in cancer patients. In addition, this article describes categories, characteristic features, and benefits of this digital media in the lifestyle modification of cancer patients.

  9. Simulated human patients and patient-centredness: The uncanny hybridity of nursing education, technology, and learning to care.

    Science.gov (United States)

    Ireland, Aileen V

    2017-01-01

    Positioned within a hybrid of the human and technology, professional nursing practice has always occupied a space that is more than human. In nursing education, technology is central in providing tools with which practice knowledge is mobilized so that students can safely engage with simulated human patients without causing harm to real people. However, while there is an increased emphasis on deploying these simulated humans as emissaries from person-centred care to demonstrate what it is like to care for real humans, the nature of what is really going on in simulation-what is real and what is simulated-is very rarely discussed and poorly understood. This paper explores how elements of postcolonial critical thought can aid in understanding the challenges of educating nurses to provide person-centred care within a healthcare culture that is increasingly reliant on technology. Because nursing education is itself a hybrid of real and simulated practice, it provides an appropriate case study to explore the philosophical question of technology in healthcare discourse, particularly as it relates to the relationship between the human patient and its uncanny simulated double. Drawing on postcolonial elements such as the uncanny, diaspora, hybridity, and créolité, the hybrid conditions of nursing education are examined in order to open up new possibilities of thinking about how learning to care is entangled with this technological space to assist in shaping professional knowledge of person-centred care. Considering these issues through a postcolonial lens opens up questions about the nature of the difficulty in using simulated human technologies in clinical education, particularly with the paradoxical aim of providing person-centred care within a climate that increasingly characterized as posthuman. © 2016 John Wiley & Sons Ltd.

  10. Patient and public involvement in scope development for a palliative care health technology assessment in europe

    NARCIS (Netherlands)

    Brereton, L.; Goyder, E.; Ingleton, C.; Gardiner, C.; Chilcott, J.; Wilt, G.J. van der; Oortwijn, W.; Mozygemba, K.; Lysdahl, K.B.; Sacchini, D.; Lepper, W.

    2014-01-01

    BACKGROUND: Patient and Public Involvement (PPI) helps to ensure that study findings are useful to end users but is under-developed in Health Technology Assessment (HTA). "INTEGRATE-HTA, (a co-funded European Union project -grant agreement 30614) is developing new methods to assess complex health

  11. Evolution of human factors research and studies of health information technologies: the role of patient safety

    NARCIS (Netherlands)

    Beuscart-Zéphir, M. C.; Borycki, E.; Carayon, P.; Jaspers, M. W. M.; Pelayo, S.

    2013-01-01

    The objective of this survey paper is to present and explain the impact of recent regulations and patient safety initiatives (EU, US and Canada) on Human Factors (HF)/Usability studies and research focusing on Health Information Technology (HIT). The authors have selected the most prominent of these

  12. Examining Health Information Technology Implementations: Case of the Patient-Centered Medical Home

    Science.gov (United States)

    Behkami, Nima A.

    2012-01-01

    It has been shown that the use of Health Information Technology (HIT) is associated with reduced cost and increased quality of care. This dissertation examined the use of registries in Patient Centered Medical Home (PCMH) practices. A survey questionnaire was sent to a nationwide group of clinics certified for being a PCMH. They were asked to…

  13. Predicting Personal Healthcare Management: Impact of Individual Characteristics on Patient Use of Health Information Technology

    Science.gov (United States)

    Sandefer, Ryan Heath

    2017-01-01

    The use of health information and health information technology by consumers is a major factor in the current healthcare systems' effort to address issues related to quality, cost, and access. Patient engagement in the healthcare process through access to information related to diagnoses, procedures, and treatment has the potential to improve…

  14. A systematic review of patient acceptance of consumer health information technology.

    Science.gov (United States)

    Or, Calvin K L; Karsh, Ben-Tzion

    2009-01-01

    A systematic literature review was performed to identify variables promoting consumer health information technology (CHIT) acceptance among patients. The electronic bibliographic databases Web of Science, Business Source Elite, CINAHL, Communication and Mass Media Complete, MEDLINE, PsycArticles, and PsycInfo were searched. A cited reference search of articles meeting the inclusion criteria was also conducted to reduce misses. Fifty-two articles met the selection criteria. Among them, 94 different variables were tested for associations with acceptance. Most of those tested (71%) were patient factors, including sociodemographic characteristics, health- and treatment-related variables, and prior experience or exposure to computer/health technology. Only ten variables were related to human-technology interaction; 16 were organizational factors; and one was related to the environment. In total, 62 (66%) were found to predict acceptance in at least one study. Existing literature focused largely on patient-related factors. No studies examined the impact of social and task factors on acceptance, and few tested the effects of organizational or environmental factors on acceptance. Future research guided by technology acceptance theories should fill those gaps to improve our understanding of patient CHIT acceptance, which in turn could lead to better CHIT design and implementation.

  15. Apology for errors: whose responsibility?

    Science.gov (United States)

    Leape, Lucian L

    2012-01-01

    When things go wrong during a medical procedure, patients' expectations are fairly straightforward: They expect an explanation of what happened, an apology if an error was made, and assurance that something will be done to prevent it from happening to another patient. Patients have a right to full disclosure; it is also therapeutic in relieving their anxiety. But if they have been harmed by our mistake, they also need an apology to maintain trust. Apology conveys respect, mutual suffering, and responsibility. Meaningful apology requires that the patient's physician and the institution both take responsibility, show remorse, and make amends. As the patient's advocate, the physician must play the lead role. However, as custodian of the systems, the hospital has primary responsibility for the mishap, for preventing that error in the future, and for compensation. The responsibility for making all this happen rests with the CEO. The hospital must have policies and practices that ensure that every injured patient is treated the way we would want to be treated ourselves--openly, honestly, with compassion, and, when indicated, with an apology and compensation. To make that happen, hospitals need to greatly expand training of physicians and others, and develop support programs for patients and caregivers.

  16. Enabling Patient Control of Personal Electronic Health Records Through Distributed Ledger Technology.

    Science.gov (United States)

    Cunningham, James; Ainsworth, John

    2017-01-01

    The rise of distributed ledger technology, initiated and exemplified by the Bitcoin blockchain, is having an increasing impact on information technology environments in which there is an emphasis on trust and security. Management of electronic health records, where both conformation to legislative regulations and maintenance of public trust are paramount, is an area where the impact of these new technologies may be particularly beneficial. We present a system that enables fine-grained personalized control of third-party access to patients' electronic health records, allowing individuals to specify when and how their records are accessed for research purposes. The use of the smart contract based Ethereum blockchain technology to implement this system allows it to operate in a verifiably secure, trustless, and openly auditable environment, features crucial to health information systems moving forward.

  17. Sensitivity of volumetric modulated arc therapy patient specific QA results to multileaf collimator errors and correlation to dose volume histogram based metrics.

    LENUS (Irish Health Repository)

    Coleman, Linda

    2013-11-01

    This study investigates the impact of systematic multileaf collimator (MLC) positional errors on gamma analysis results used for quality assurance (QA) of Rapidarc treatments. In addition, this study evaluates the relationship of these gamma analysis results and clinical dose volume histogram metrics (DVH) for Rapidarc treatment plans.

  18. Learning from Errors

    Science.gov (United States)

    Metcalfe, Janet

    2017-01-01

    Although error avoidance during learning appears to be the rule in American classrooms, laboratory studies suggest that it may be a counterproductive strategy, at least for neurologically typical students. Experimental investigations indicate that errorful learning followed by corrective feedback is beneficial to learning. Interestingly, the…

  19. Medication errors: definitions and classification

    Science.gov (United States)

    Aronson, Jeffrey K

    2009-01-01

    To understand medication errors and to identify preventive strategies, we need to classify them and define the terms that describe them. The four main approaches to defining technical terms consider etymology, usage, previous definitions, and the Ramsey–Lewis method (based on an understanding of theory and practice). A medication error is ‘a failure in the treatment process that leads to, or has the potential to lead to, harm to the patient’. Prescribing faults, a subset of medication errors, should be distinguished from prescription errors. A prescribing fault is ‘a failure in the prescribing [decision-making] process that leads to, or has the potential to lead to, harm to the patient’. The converse of this, ‘balanced prescribing’ is ‘the use of a medicine that is appropriate to the patient's condition and, within the limits created by the uncertainty that attends therapeutic decisions, in a dosage regimen that optimizes the balance of benefit to harm’. This excludes all forms of prescribing faults, such as irrational, inappropriate, and ineffective prescribing, underprescribing and overprescribing. A prescription error is ‘a failure in the prescription writing process that results in a wrong instruction about one or more of the normal features of a prescription’. The ‘normal features’ include the identity of the recipient, the identity of the drug, the formulation, dose, route, timing, frequency, and duration of administration. Medication errors can be classified, invoking psychological theory, as knowledge-based mistakes, rule-based mistakes, action-based slips, and memory-based lapses. This classification informs preventive strategies. PMID:19594526

  20. A Technological Review of the Instrumented Footwear for Rehabilitation with a Focus on Parkinson's Disease Patients.

    Science.gov (United States)

    Maculewicz, Justyna; Kofoed, Lise Busk; Serafin, Stefania

    2016-01-01

    In this review article, we summarize systems for gait rehabilitation based on instrumented footwear and present a context of their usage in Parkinson's disease (PD) patients' auditory and haptic rehabilitation. We focus on the needs of PD patients, but since only a few systems were made with this purpose, we go through several applications used in different scenarios when gait detection and rehabilitation are considered. We present developments of the designs, possible improvements, and software challenges and requirements. We conclude that in order to build successful systems for PD patients' gait rehabilitation, technological solutions from several studies have to be applied and combined with knowledge from auditory and haptic cueing.

  1. Health Information Technology in Healthcare Quality and Patient Safety: Literature Review.

    Science.gov (United States)

    Feldman, Sue S; Buchalter, Scott; Hayes, Leslie W

    2018-06-04

    The area of healthcare quality and patient safety is starting to use health information technology to prevent reportable events, identify them before they become issues, and act on events that are thought to be unavoidable. As healthcare organizations begin to explore the use of health information technology in this realm, it is often unclear where fiscal and human efforts should be focused. The purpose of this study was to provide a foundation for understanding where to focus health information technology fiscal and human resources as well as expectations for the use of health information technology in healthcare quality and patient safety. A literature review was conducted to identify peer-reviewed publications reporting on the actual use of health information technology in healthcare quality and patient safety. Inductive thematic analysis with open coding was used to categorize a total of 41 studies. Three pre-set categories were used: prevention, identification, and action. Three additional categories were formed through coding: challenges, outcomes, and location. This study identifies five main categories across seven study settings. A majority of the studies used health IT for identification and prevention of healthcare quality and patient safety issues. In this realm, alerts, clinical decision support, and customized health IT solutions were most often implemented. Implementation, interface design, and culture were most often noted as challenges. This study provides valuable information as organizations determine where they stand to get the most "bang for their buck" relative to health IT for quality and patient safety. Knowing what implementations are being effectivity used by other organizations helps with fiscal and human resource planning as well as managing expectations relative to cost, scope, and outcomes. The findings from this scan of the literature suggest that having organizational champion leaders that can shepherd implementation, impact culture

  2. Action errors, error management, and learning in organizations.

    Science.gov (United States)

    Frese, Michael; Keith, Nina

    2015-01-03

    Every organization is confronted with errors. Most errors are corrected easily, but some may lead to negative consequences. Organizations often focus on error prevention as a single strategy for dealing with errors. Our review suggests that error prevention needs to be supplemented by error management--an approach directed at effectively dealing with errors after they have occurred, with the goal of minimizing negative and maximizing positive error consequences (examples of the latter are learning and innovations). After defining errors and related concepts, we review research on error-related processes affected by error management (error detection, damage control). Empirical evidence on positive effects of error management in individuals and organizations is then discussed, along with emotional, motivational, cognitive, and behavioral pathways of these effects. Learning from errors is central, but like other positive consequences, learning occurs under certain circumstances--one being the development of a mind-set of acceptance of human error.

  3. A randomized controlled trial comparing customized versus standard headrests for head and neck radiotherapy immobilization in terms of set-up errors, patient comfort and staff satisfaction (ICORG 08-09)

    International Nuclear Information System (INIS)

    Howlin, C.; O'Shea, E.; Dunne, M.; Mullaney, L.; McGarry, M.; Clayton-Lea, A.; Finn, M.; Carter, P.; Garret, B.; Thirion, P.

    2015-01-01

    Purpose: To recommend a specific headrest, customized or standard, for head and neck radiotherapy patients in our institution based primarily on an evaluation of set-up accuracy, taking into account a comparison of patient comfort, staff and patient satisfaction, and resource implications. Methods and materials: Between 2008 and 2009, 40 head and neck patients were randomized to either a standard (Arm A, n = 21) or customized (Arm B, n = 19) headrest, and immobilized with a customized thermoplastic mask. Set-up accuracy was assessed using electronic portal images (EPI). Random and systematic set-up errors for each arm were determined from 668 EPIs, which were analyzed by one Radiation Therapist. Patient comfort was assessed using a visual analogue scale (VAS) and staff satisfaction was measured using an in-house questionnaire. Resource implications were also evaluated. Results: The difference in set-up errors between arms was not significant in any direction. However, in this study the standard headrest (SH) arm performed well, with set-up errors comparative to customized headrests (CHs) in previous studies. CHs require regular monitoring and 47% were re-vacuumed making them more resource intensive. Patient comfort and staff satisfaction were comparable in both arms. Conclusion: The SH provided similar treatment accuracy and patient comfort compared with the CH. The large number of CHs that needed to be re-vacuumed undermines their reliability for radiotherapy schedules that extend beyond 34 days from the initial CT scan. Accordingly the CH was more resource intensive without improving the accuracy of positioning, thus the standard headrest is recommended for continued use at our institution

  4. [Medication errors in Spanish intensive care units].

    Science.gov (United States)

    Merino, P; Martín, M C; Alonso, A; Gutiérrez, I; Alvarez, J; Becerril, F

    2013-01-01

    To estimate the incidence of medication errors in Spanish intensive care units. Post hoc study of the SYREC trial. A longitudinal observational study carried out during 24 hours in patients admitted to the ICU. Spanish intensive care units. Patients admitted to the intensive care unit participating in the SYREC during the period of study. Risk, individual risk, and rate of medication errors. The final study sample consisted of 1017 patients from 79 intensive care units; 591 (58%) were affected by one or more incidents. Of these, 253 (43%) had at least one medication-related incident. The total number of incidents reported was 1424, of which 350 (25%) were medication errors. The risk of suffering at least one incident was 22% (IQR: 8-50%) while the individual risk was 21% (IQR: 8-42%). The medication error rate was 1.13 medication errors per 100 patient-days of stay. Most incidents occurred in the prescription (34%) and administration (28%) phases, 16% resulted in patient harm, and 82% were considered "totally avoidable". Medication errors are among the most frequent types of incidents in critically ill patients, and are more common in the prescription and administration stages. Although most such incidents have no clinical consequences, a significant percentage prove harmful for the patient, and a large proportion are avoidable. Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  5. Community pharmacy patient perceptions of a pharmacy-initiated mobile technology app to improve adherence.

    Science.gov (United States)

    DiDonato, Kristen L; Liu, Yifei; Lindsey, Cameron C; Hartwig, David Matthew; Stoner, Steven C

    2015-10-01

    To determine patient perceptions of using a demonstration application (app) of mobile technology to improve medication adherence and to identify desired features to assist in the management of medications. A qualitative study using key informant interviews was conducted in a community pharmacy chain for patients aged 50 and older, on statin therapy and owning a smart device. Three main themes emerged from 24 interviews at four pharmacy locations, which included benefits, barriers and desired features of the app. Benefits such as accessibility, privacy, pros of appearance and beneficiaries were more likely to lead to usage of the app. Barriers that might prevent usage of the app were related to concerns of appearance, the burden it might cause for others, cost, privacy, motivation and reliability. Specific features patients