Abstract
Concern over the levels of patient safety within hospitals was raised following a series of studies showing unacceptable rates (3–17% of admissions) of adverse events (injury to patients). Government health agencies acknowledged that the standard of safety for patients was unacceptable and that healthcare providers would be required to tackle this issue. Other industries, particularly in the more hazardous sectors such as energy production, take a very systematic approach to managing safety. They have realized that human factors play a major contributing role to accident causation, but that this encompasses not just the humans operating the system, but also the humans who are managing the organization. Leape and colleagues [1] argued that many hospital systems are designed to rely on the error-free performance of individuals, whereas in industry it is appreciated that human error is inevitable and that accidents occur due to both human failures and latent conditions. Both are influenced by the underlying safety culture of the organisation (e.g. level of management commitment to safety). Drawing on psychological research into safety management in high-risk industries, this paper examines three techniques used to diagnose the state of safety: measuring safety climate; assessing senior managers' commitment to safety; and evaluating nontechnical skills for safety critical positions.
Highlights
Neoplastic tissue contains elevated levels of choline-containing metabolites [1,2]
We examined the extent to which the lower mammographic sensitivity found in hormone replacement therapy (HRT) users could be explained by any association of HRT use with higher density and more difficult to detect cancers
The results suggest that applying compression does not ensure breast thickness reduction and observing physical changes does not guarantee that breast thickness has been minimised
Summary
Neoplastic tissue contains elevated levels of choline-containing metabolites (tCho) [1,2]. The presence of spiculation arising from a mass detected at mammography makes malignancy a probable diagnosis This is confirmed by this review of the first 8 years of screening in East Sussex where only 3.6% of masses with spiculation were benign at excision (24 out of 668), compared with 33.3% of masses without spiculation (102 out of 306). When breast core biopsy reveals lobular neoplasia (lobular carcinoma in situ [LCIS] or atypical lobular hyperplasia [ALH]) a management dilemma follows, as uncertainty regarding the significance of LCIS/ALH exists. Is this an indicator of increased risk of breast cancer or should it be considered a marker for more serious local pathology? Is this an indicator of increased risk of breast cancer or should it be considered a marker for more serious local pathology? Should surgical excision be undertaken in these cases?
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