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https://www.readbyqxmd.com/read/29148087/an-agent-based-model-of-evolving-community-flood-risk
#1
Gina L Tonn, Seth D Guikema
Although individual behavior plays a major role in community flood risk, traditional flood risk models generally do not capture information on how community policies and individual decisions impact the evolution of flood risk over time. The purpose of this study is to improve the understanding of the temporal aspects of flood risk through a combined analysis of the behavioral, engineering, and physical hazard aspects of flood risk. Additionally, the study aims to develop a new modeling approach for integrating behavior, policy, flood hazards, and engineering interventions...
November 17, 2017: Risk Analysis: An Official Publication of the Society for Risk Analysis
https://www.readbyqxmd.com/read/29120292/survival-and-negotiation-narratives-of-severe-near-miss-neonatal-complications-of-syrian-women-in-lebanon
#2
Livia Wick
The World Health Organization has elaborated a maternal and neonatal near-miss reporting, audit and feedback system designed to improve the quality of care during and after childbirth. As part of a four-hospital comparative study in the Middle East, this article discusses the experiences of mothers whose newborns suffered from severe complications at birth in the Rafik Hariri University Hospital, the only public hospital in Beirut. Based on in-depth home interviews several weeks after childbirth, it aims to explore the experience of neonatal near-miss events through the mothers' birth narratives...
October 2017: Reproductive Health Matters
https://www.readbyqxmd.com/read/29091463/falls-from-agricultural-machinery-risk-factors-related-to-work-experience-worked-hours-and-operators-behavior
#3
Federica Caffaro, Michele Roccato, Margherita Micheletti Cremasco, Eugenio Cavallo
Objective We investigated the risk factors for falls when egressing from agricultural tractors, analyzing the role played by worked hours, work experience, operators' behavior, and near misses. Background Many accidents occur within the agricultural sector each year. Among them, falls while dismounting the tractor represent a major source of injuries. Previous studies pointed out frequent hazardous movements and incorrect behaviors adopted by operators to exit the tractor cab. However, less is known about the determinants of such behaviors...
November 1, 2017: Human Factors
https://www.readbyqxmd.com/read/29076855/creating-a-fair-and-just-culture-in-schools-of-nursing
#4
Jane Barnsteiner, Joanne Disch
: In recent years, health care organizations have been moving away from a culture that responds to errors and near misses with "shame and blame" and toward a fair and just culture. Such a culture encourages and rewards people for speaking up about safety-related concerns, thus allowing the information to be used for system improvement. In part 1 of this series, we reported on findings from a study that examined how nursing schools handled student errors and near misses. We found that few nursing schools had a policy or a reporting tool concerning these events; and that when policies did exist, the majority did not reflect the principles of a fair and just culture...
November 2017: American Journal of Nursing
https://www.readbyqxmd.com/read/29048467/identification-of-copy-number-variations-and-translocations-in-cancer-cells-from-hi-c-data
#5
Abhijit Chakraborty, Ferhat Ay
Motivation: Eukaryotic chromosomes adapt a complex and highly dynamic three-dimensional (3D) structure, which profoundly affects different cellular functions and outcomes including changes in epigenetic landscape and in gene expression. Making the scenario even more complex, cancer cells harbor chromosomal abnormalities (e.g., copy number variations (CNVs) and translocations) altering their genomes both at the sequence level and at the level of 3D organization. High-throughput chromosome conformation capture techniques (e...
October 18, 2017: Bioinformatics
https://www.readbyqxmd.com/read/29028690/adverse-event-reporting-harnessing-residents-to-improve-patient-safety
#6
Sarah E Tevis, Ryan K Schmocker, Tosha B Wetterneck
OBJECTIVES: Reporting of adverse and near miss events are essential to identify system level targets to improve patient safety. Resident physicians historically report few events despite their role as front-line patient care providers. We sought to evaluate barriers to adverse event reporting in an effort to improve reporting. Our main outcomes were as follows: resident attitudes about event reporting and the frequency of event reporting before and after interventions to address reporting barriers...
October 13, 2017: Journal of Patient Safety
https://www.readbyqxmd.com/read/29023218/out-of-hospital-pediatric-patient-safety-events-results-of-the-csi-chart-review
#7
Garth Meckler, Matthew Hansen, William Lambert, Kerth O'Brien, Caitlin Dickinson, Kathryn Dickinson, Joshua Van Otterloo, Jeanne-Marie Guise
OBJECTIVE: Studies of adult hospital patients have identified medical errors as a significant cause of morbidity and mortality. Little is known about the frequency and nature of pediatric patient safety events in the out-of-hospital setting. We sought to quantify pediatric patient safety events in EMS and identify patient, call, and care characteristics associated with potentially severe events. METHODS: As part of the Children's Safety Initiative -EMS, expert panels independently reviewed charts of pediatric critical ambulance transports in a metropolitan area over a three-year period...
October 12, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28969656/inadequate-programming-insufficient-communication-and-non-compliance-with-the-basic-principles-of-maternal-death-audits-in-health-districts-in-burkina-faso-a-qualitative-study
#8
Boukaré Congo, Djénéba Sanon, Tieba Millogo, Charlemagne Marie Ouedraogo, Wambi Maurice E Yaméogo, Ziemlé Clement Meda, Seni Kouanda
BACKGROUND: Implementation of quality maternal death audits requires good programming, good communication and compliance with core principles. Studies on compliance with core principles in the conduct of maternal death audits (MDAs) exist but were conducted in urban areas, at the 2nd or 3rd level of the healthcare system, in experimental situations, or in a context of skills-building projects or technical platforms with an emphasis on the review of "near miss". This study aims to fill the gap of evidence on the implementation of MDAs in rural settings, at the first level of care and in the routine care situation in Burkina Faso...
September 29, 2017: Reproductive Health
https://www.readbyqxmd.com/read/28885381/characteristics-of-medical-adverse-events-near-misses-associated-with-laparoscopic-thoracoscopic-surgery-a-retrospective-study-based-on-the-japanese-national-database-of-medical-adverse-events
#9
Takashige Abe, Sachiyo Murai, Yasuyuki Nasuhara, Nobuo Shinohara
OBJECTIVES: The aim of this study was to clarify the characteristics of adverse events/near misses during laparoscopic/thoracoscopic surgery. METHODS: Using relevant key words for minimally invasive surgeries, 540 records were identified in the database of the Japan Council for Quality Health Care. After data review and the classification of adverse events, 746 events associated with laparoscopic (laparo group) and/or thoracoscopic (thoraco group) surgery were identified...
September 6, 2017: Journal of Patient Safety
https://www.readbyqxmd.com/read/28879688/building-a-learning-culture-and-prevention-of-error-to-near-miss-or-not
#10
EDITORIAL
Anthony Arnold
This editorial provides an insight into learning and prevention of error through near miss event reporting.
September 2017: Journal of Medical Radiation Sciences
https://www.readbyqxmd.com/read/28878928/evaluation-of-a-guided-continuous-quality-improvement-program-in-community-pharmacies
#11
Chanadda Chinthammit, Michael T Rupp, Edward P Armstrong, Tara Modisett, Rebecca P Snead, Terri L Warholak
BACKGROUND: The importance of creating and sustaining a strong culture of patient safety has been recognized as a critical component of safe medication use. This study aims to assess changes in attitudes toward patient safety culture and frequency of quality-related event (QRE) reporting after guided implementation of a continuous quality improvement (CQI) program in a panel of community pharmacies in the United States (U.S.). METHODS: Twenty-one community pharmacies volunteered to participate in the project and were randomly assigned to intervention or control groups...
2017: Journal of Pharmaceutical Policy and Practice
https://www.readbyqxmd.com/read/28875548/bacterial-contamination-of-platelet-components-not-detected-by-bact-alert%C3%A2
#12
M A Abela, S Fenning, K A Maguire, K G Morris
OBJECTIVES: To investigate the possible causes for false negative results in BacT/ALERT® 3D Signature System despite bacterial contamination of platelet units. BACKGROUND: The Northern Ireland Blood Transfusion Service (NIBTS) routinely extends platelet component shelf life to 7 days. Components are sampled and screened for bacterial contamination using an automated microbial detection system, the BacT/ALERT® 3D Signature System. We report on three platelet components with confirmed bacterial contamination, which represent false negative BacT/ALERT® results and near-miss serious adverse events...
September 5, 2017: Transfusion Medicine
https://www.readbyqxmd.com/read/28865683/evaluation-of-near-miss-and-adverse-events-in-radiation-oncology-using-a-comprehensive-causal-factor-taxonomy
#13
Matthew B Spraker, Robert Fain, Olga Gopan, Jing Zeng, Matthew Nyflot, Loucille Jordan, Gabrielle Kane, Eric Ford
PURPOSE: Incident learning systems (ILSs) are a popular strategy for improving safety in radiation oncology (RO) clinics, but few reports focus on the causes of errors in RO. The goal of this study was to test a causal factor taxonomy developed in 2012 by the American Association of Physicists in Medicine and adopted for use in the RO: Incident Learning System (RO-ILS). METHODS AND MATERIALS: Three hundred event reports were randomly selected from an institutional ILS database and Safety in Radiation Oncology (SAFRON), an international ILS...
September 2017: Practical Radiation Oncology
https://www.readbyqxmd.com/read/28851308/patterns-and-determinants-of-pathways-to-reach-comprehensive-emergency-obstetric-and-neonatal-care-cemonc-in-south-sudan-qualitative-diagrammatic-pathway-analysis
#14
Khalifa Elmusharaf, Elaine Byrne, Ayat AbuAgla, Amal AbdelRahim, Mary Manandhar, Egbert Sondorp, Diarmuid O'Donovan
BACKGROUND: Maternity referral systems have been under-documented, under-researched, and under-theorised. Responsive emergency referral systems and appropriate transportation are cornerstones in the continuum of care and central to the complex health system. The pathways that women follow to reach Emergency Obstetric and Neonatal Care (EmONC) once a decision has been made to seek care have received relatively little attention. The aim of this research was to identify patterns and determinants of the pathways pregnant women follow from the onset of labour or complications until they reach an appropriate health facility...
August 29, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28843757/changing-operating-room-culture-implementation-of-a-postoperative-debrief-and-improved-safety-culture
#15
Stephen T Magill, Doris D Wang, W Caleb Rutledge, Darryl Lau, Mitchel S Berger, Sujatha Sankaran, Catherine Y Lau, Sarah G Imershein
BACKGROUND: Patient safety is foundational to neurosurgical care. Postprocedural "debrief" checklists have been proposed to improve patient safety, but data about their use in neurosurgery are limited. Here, we implemented an initiative to routinely perform postoperative debriefs and evaluated the impact of debriefing on operating room (OR) safety culture. METHODS: A 10-question safety attitude questionnaire (SAQ) was sent to neurosurgical OR staff at a major academic medical center before and 18 months after the implementation of a postoperative debriefing initiative...
November 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28842446/a-natural-history-study-of-x-linked-myotubular-myopathy
#16
Kimberly Amburgey, Etsuko Tsuchiya, Sabine de Chastonay, Michael Glueck, Rachel Alverez, Cam-Tu Nguyen, Anne Rutkowski, Joseph Hornyak, Alan H Beggs, James J Dowling
OBJECTIVE: To define the natural history of X-linked myotubular myopathy (MTM). METHODS: We performed a cross-sectional study that included an online survey (n = 35) and a prospective, 1-year longitudinal investigation using a phone survey (n = 33). RESULTS: We ascertained data from 50 male patients with MTM and performed longitudinal assessments on 33 affected individuals. Consistent with existing knowledge, we found that MTM is a disorder associated with extensive morbidities, including wheelchair (86...
September 26, 2017: Neurology
https://www.readbyqxmd.com/read/28799352/free-energy-landscape-and-molecular-pathways-of-gas-hydrate-nucleation
#17
Yuanfei Bi, Anna Porras, Tianshu Li
Despite the significance of gas hydrates in diverse areas, a quantitative knowledge of hydrate formation at a molecular level is missing. The impediment to acquiring this understanding is primarily attributed to the stochastic nature and ultra-fine scales of nucleation events, posing a great challenge for both experiment and simulation to explore hydrate nucleation. Here we employ advanced molecular simulation methods, including forward flux sampling (FFS), pB histogram analysis, and backward flux sampling, to overcome the limit of direct molecular simulation for exploring both the free energy landscape and molecular pathways of hydrate nucleation...
December 7, 2016: Journal of Chemical Physics
https://www.readbyqxmd.com/read/28768045/examining-factors-that-influence-the-existence-of-heinrich-s-safety-triangle-using-site-specific-h-s-data-from-more-than-25-000-establishments
#18
Patrick L Yorio, Susan M Moore
In the 1930s, Heinrich established one of the most prominent and enduring accident prevention theories when he concluded that high severity occupational safety and health (OSH) incidents are preceded by numerous lower severity incidents and near misses. Seventy-five years of theory expansion/interpretation includes two fundamental tenets: (1) the ratio of lower to higher severity incidents exists in the form of a "safety-triangle" and (2) similar causes underlie both high and low severity events. Although used extensively to inform public policy and establishment-level health and safety priorities, recent research challenges the validity of the two tenets...
August 2, 2017: Risk Analysis: An Official Publication of the Society for Risk Analysis
https://www.readbyqxmd.com/read/28757402/brachytherapy-patient-safety-events-in-an-academic-radiation-medicine%C3%A2-program
#19
Shira Felder, Lyndon Morley, Elizabeth Ng, Kitty Chan, Heather Ballantyne, Anne Di Tomasso, Jette Borg, Jean-Pierre Bissonnette, Stephen Breen, John Waldron, Alexandra Rink, Michael Milosevic
PURPOSE: To describe the incidence and type of brachytherapy patient safety events over 10 years in an academic brachytherapy program. METHODS AND MATERIALS: Brachytherapy patient safety events reported between January 2007 and August 2016 were retrieved from the incident reporting system and reclassified using the recently developed National System for Incident Reporting in Radiation Treatment taxonomy. A multi-incident analysis was conducted to identify common themes and key learning points...
July 27, 2017: Brachytherapy
https://www.readbyqxmd.com/read/28754161/a-cross-sectional-study-of-maternal-near-miss-and-mortality-at-a-rural-tertiary-centre-in-southern-nigeria
#20
Ikechukwu Innocent Mbachu, Chukwuemeka Ezeama, Kelechi Osuagwu, Osita Samuel Umeononihu, Chibuzor Obiannika, Nkeiru Ezeama
BACKGROUND: The study evaluated the pattern of severe maternal outcome, near miss indicators and associated patient and healthcare factors at a private referral hospital in rural Nigeria. METHODS: This was a cross sectional study conducted from September 2014 to August 2015 in Madonna University Teaching Hospital Elele, Rivers State, Nigeria. Pregnant and postpartum women were recruited for the study using Nigeria near miss network proforma which was adopted from the WHO near miss proforma...
July 28, 2017: BMC Pregnancy and Childbirth
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