Absence Of Error Research Articles

When Things Go Right: Safety II in an Academic Emergency Department.

Objectives Historically, "safety" has been defined as an absence of error. Practice variability of any kind has been viewed as a threat. This is termed Safety I. Meanwhile, Safety II posits that clinician practice variability is a necessary adaptation required to meet patient needs in a complex healthcare system. We hypothesize that clinicians in the emergency department (ED) make proactive adaptations and utilize practice variability to enhance safety. Methods This is a cross-sectional survey-based study of clinical team members at a tertiary care academic ED with an annual census of 76,000. Qualitative data on instances of proactive safety were collected and analyzed via inductive response analysis. Ratings of support for practice adjustments and experiences of negative emotions during practice variability were collected using 5-point Likert scales. Results There were 84 respondents, of which 33 (39%) were nurses, 28 (33%) were physicians, and 23 (27%) held other clinical roles. Qualitative data included 128 instances of harm prevention, with some respondents describing more than one. Instances include proactive safety via collaboration (n = 47; 36.72%), time-based interventions (n = 46; 35.94%), physical harm prevention (n = 27; 21.10%), and patient/visitor interactions (n = 8; 6.25%). Of respondents, 73.17% (n = 30) felt that policies matched daily work most of the time, and 92.68% (n = 38) felt enabled to adapt to the needs of a patient most of the time. Experiences of self-doubt, fear of repercussion, or anxiety occurred most when adhering to a policy despite patient needs (n = 20; 48.78%). Conclusions Clinical team members report keeping patients safe through various forms of behavior adaptations, most frequently reporting collaboration beyond usual expected practice. Respondents report policies to match daily work most of the time and feel enabled to adapt to the needs of patients. Feelings of self-doubt, fear of repercussion, or anxiety were reported most frequently when clinicians adhered to a policy despite the needs of a patient.

Life Before and After

Abstract ‘Good’ editorial practice – in this case, post-developmental copy-editing work – is typically measured by an editor’s ‘positive invisibility’ (J. Hargrave, Teaching Publishing and Editorial Practice, Cambridge University Press, 2022). Traditionally, editing has been considered a ‘role [that] tends to be pushed into the margins’, taking place ‘behind the scenes’ and existing ‘everywhere and, therefore, nowhere’ (S. Greenberg, ‘When the Editor Disappears, Does Editing Disappear?’, Convergence, 2010, p. 8); a hidden, mysterious business transparent only to those who practise it. Editorial practice is hence often (mis)judged by physical invisibility on the page: that is, an absence of error. An editor’s value is predicated on their positive invisibility, an outcome of which can be their marginalization. With the distinction between work and home life essentially eradicated in the COVID-19 gig economy of 2020–2021, central questions posed for this context were simply: ‘How did editors cope with the work-to-home transition?’, ‘Did editors become more invisible and/or marginalized during COVID-19?’, and, ‘If so, what was the nature of this invisibility and/or marginalization?’ Editors were contacted in 2020 and 2022 to describe their editorial practice and its potential (in)visibility before, during, and after the 2020–2021 pandemic lockdowns. Their responses exposed their at times polarized experiences and work – life challenges, and ongoing systemic problems in industry.

Coping With Radiology Malpractice Litigation.

Medical error is commonplace. The uncertainties of any endeavor involving human beings necessarily entails not only occasional mistakes but adverse outcomes as well, even in the absence of error. The range of mishaps and complications is vast, from trivial oversight of incidental abnormalities of no consequence to gross and lasting harm to patients and their dependents. The severity of the outcome may have little to do with how egregious the oversight was: small mistakes can have catastrophic consequences, just as shocking errors may prove immaterial.

Software Bug Detection Causes a Shift From Bottom-Up to Top-Down Effective Connectivity Involving the Insula Within the Error-Monitoring Network.

The neural correlates of software programming skills have been the target of an increasing number of studies in the past few years. Those studies focused on error-monitoring during software code inspection. Others have studied task-related cognitive load as measured by distinct neurophysiological measures. Most studies addressed only syntax errors (shallow level of code monitoring). However, a recent functional MRI (fMRI) study suggested a pivotal role of the insula during error-monitoring when challenging deep-level analysis of code inspection was required. This raised the hypothesis that the insula is causally involved in deep error-monitoring. To confirm this hypothesis, we carried out a new fMRI study where participants performed a deep source-code comprehension task that included error-monitoring to detect bugs in the code. The generality of our paradigm was enhanced by comparison with a variety of tasks related to text reading and bugless source-code understanding. Healthy adult programmers (N = 21) participated in this 3T fMRI experiment. The activation maps evoked by error-related events confirmed significant activations in the insula [p(Bonferroni) < 0.05]. Importantly, a posterior-to-anterior causality shift was observed concerning the role of the insula: in the absence of error, causal directions were mainly bottom-up, whereas, in their presence, the strong causal top-down effects from frontal regions, in particular, the anterior cingulate cortex was observed.

Impact of Carbohydrate Counting Error on Glycemic Control in Open-Loop Management of Type 1 Diabetes: Quantitative Assessment Through an In Silico Trial.

In the management of type 1 diabetes (T1D), systematic and random errors in carb-counting can have an adverse effect on glycemic control. In this study, we performed an in silico trial aiming at quantifying the impact of different levels of carb-counting error on glycemic control. The T1D patient decision simulator was used to simulate 7-day glycemic profiles of 100 adults using open-loop therapy. The simulation was repeated for different values of systematic and random carb-counting errors, generated with Gaussian distribution varying the error mean from -10% to +10% and standard deviation (SD) from 0% to 50%. The effect of the error was evaluated by computing the difference of time inside (∆TIR), above (∆TAR) and below (∆TBR) the target glycemic range (70-180mg/dl) compared to the reference case, that is, absence of error. Finally, 3 linear regression models were developed to mathematically describe how error mean and SD variations result in ∆TIR, ∆TAR, and ∆TBR changes. Random errors globally deteriorate the glycemic control; systematic underestimations lead to, on average, up to 5.2% more TAR than the reference case, while systematic overestimation results in up to 0.8% more TBR. The different time in range metrics were linearly related with error mean and SD (R2>0.95), with slopes of , for ∆TIR, , for ∆TAR, and , for ∆TBR. The quantification of carb-counting error impact performed in this work may be useful understanding causes of glycemic variability and the impact of possible therapy adjustments or behavior changes in different glucose metrics.

Prospective, Blinded Evaluation of Template-Based Cesarean Documentation Error in an Obstetric Training Program.

Cesarean operative report accuracy impacts postoperative care and future obstetric decision-making. The impact of electronic health record template use on cesarean documentation error remains unknown. The aim of the study was to describe the incidence of resident physician documentation error in cesarean operative reports using electronic health record templates. Attending physicians completed a standardized audit form after cesarean deliveries, which was compared with the resident operative report. Resident physicians were blinded to the auditing process. Errors were classified as none, major, or minor using predefined definitions. Author and operative characteristics were collected for comparative and predictive analyses. Data were analyzed by presence or absence of error. We reviewed 100 cesarean operative reports. Major and minor errors were encountered in 33% and 53% of operative notes, respectively. Advancing training level was associated with lower incidence of major error (50%, for postgraduate year [PGY] 1, 33% for PGY 2, and 0% for PGY 3/4, P = 0.02), but minor errors were similar among training level, P = 0.48. Operative duration, documentation interval, and shift characteristics were similar in cases with and without documentation errors. In multiple logistic regression, PGY was predictive of major documentation error (adjusted odds ratio = 0.39, 95% confidence interval = 0.17-0.92). A high incidence of clinically significant documentation error was observed in a residency training program using standardized templates for cesarean operative reports. Incidence of major error decreased with increasing training, but minor error was similar across levels of training. These data suggest that measures should be taken to improve documentation accuracy in medical training to provide optimal obstetric care.

Thresholds, rules and defensive strategies: how physicians learn from their prior diagnosis-related experiences

Background Health professionals are encouraged to learn from their errors. Determining how primary care physicians (PCPs) react to a case, in which their original diagnosis differed from the final outcome, could provide new insights on how they learn from experiences. We explored how PCPs altered their diagnostic evaluation of future patients after cases where the originally assumed diagnosis turned out to be wrong. Methods We asked German PCPs to complete an online survey where they described how the patient concerned originally presented, the subsequent course of events and whether they would change their diagnostic work-up of future patients. Qualitative methods were used to analyze narrative text obtained by this survey. Results A total of 29 PCPs submitted cases, most of which were ultimately found to be more severe than originally assumed. PCPs (n = 27) reflected on changes to their subsequent clinical decisions in the form of general maxims (n = 20) or more specific rules (n = 11). Most changes would have resulted in a lower threshold for investigations, referral and/or a more extensive collection of diagnostic information. PCPs decided not only to listen more often to their intuition (gut feelings), but to also practice more analytical reasoning. Participants felt the need for change of practice even if no clinical standards had been violated in the diagnosis of that case. Some decided to resort to defensive strategies in the future. Conclusions We describe mechanisms by which physicians calibrate their decision thresholds, as well as their cognitive mode (intuitive vs. analytical). PCPs reported the need for change in clinical practice despite the absence of error in some cases.

Chronic obstructive pulmonary disease exacerbation and inhaler device handling: real-life assessment of 2935 patients.

Acute exacerbations of chronic obstructive pulmonary disease (COPD) can be prevented by inhaled treatment. Errors in inhaler handling, not taken into account in clinical trials, could impact drug delivery and minimise treatment benefit. We aimed to assess real-life inhaler device handling in COPD patients and its association with COPD exacerbations.To this end, 212 general practitioners and 50 pulmonologists assessed the handling of 3393 devices used for continuous treatment of COPD in 2935 patients. Handling errors were observed in over 50% of handlings, regardless of the device used. Critical errors compromising drug delivery were respectively made in 15.4%, 21.2%, 29.3%, 43.8%, 46.9% and 32.1% of inhalation assessment tests with Breezhaler® (n=876), Diskus® (n=452), Handihaler® (n=598), pressurised metered-dose inhaler (pMDI) (n=422), Respimat® (n=625) and Turbuhaler® (n=420).The proportion of patients requiring hospitalisation or emergency room visits in the past 3 months for severe COPD exacerbation was 3.3% (95% CI 2.0-4.5) in the absence of error and 6.9% (95% CI 5.3-8.5) in the presence of critical error (OR 1.86, 95% CI 1.14-3.04, p<0.05).Handling errors of inhaler devices are underestimated in real life and are associated with an increased rate of severe COPD exacerbation. Training in inhaler use is an integral part of COPD management.

An Initial Assessment of the Surface Reference Technique Applied to Data from the Dual-Frequency Precipitation Radar (DPR) on the GPM Satellite

AbstractIt has long been recognized that path-integrated attenuation (PIA) can be used to improve precipitation estimates from high-frequency weather radar data. One approach that provides an estimate of this quantity from airborne or spaceborne radar data is the surface reference technique (SRT), which uses measurements of the surface cross section in the presence and absence of precipitation. Measurements from the dual-frequency precipitation radar (DPR) on the Global Precipitation Measurement (GPM) satellite afford the first opportunity to test the method for spaceborne radar data at Ka band as well as for the Ku-band–Ka-band combination.The study begins by reviewing the basis of the single- and dual-frequency SRT. As the performance of the method is closely tied to the behavior of the normalized radar cross section (NRCS or σ0) of the surface, the statistics of σ0 derived from DPR measurements are given as a function of incidence angle and frequency for ocean and land backgrounds over a 1-month period. Several independent estimates of the PIA, formed by means of different surface reference datasets, can be used to test the consistency of the method since, in the absence of error, the estimates should be identical. Along with theoretical considerations, the comparisons provide an initial assessment of the performance of the single- and dual-frequency SRT for the DPR. The study finds that the dual-frequency SRT can provide improvement in the accuracy of path attenuation estimates relative to the single-frequency method, particularly at Ku band.

How people learn features in the absence of classification error

Models of category learning often assume that exemplar features are learned in proportion to how much they reduce classification error. In contrast, experimental evidence suggests that people continue to learn features even when classification is perfect. We present three experiments that test explanations for how people might learn features in the absence of error. In Experiment 1, we varied the type of feedback participants received. In Experiment 2, we introduced a secondary task during the feedback phase, and in Experiment 3, we restricted the response window and varied the feedback. In all cases, we found that participants learn many more features than they need to classify the exemplars. Our results suggest that participants learn the internal correlations between features, rather than directly forming associations between features and the category label. This finding places restrictions on the types of categorisation models that can satisfactorily explain learning in the absence of classification error.

Decay of Motor Memories in the Absence of Error

When motor commands are accompanied by an unexpected outcome, the resulting error induces changes in subsequent commands. However, when errors are artificially eliminated, changes in motor commands are not sustained but show decay. Why does the adaptation-induced change in motor output decay in the absence of error? A prominent idea is that decay reflects the stability of the memory. We show results that challenge this idea and instead suggest that motor output decays because the brain actively disengages a component of the memory. Humans adapted their reaching movements to a perturbation and were then introduced to a long period of trials in which errors were absent (error-clamp). We found that, in some subjects, motor output did not decay at the onset of the error-clamp block but a few trials later. We manipulated the kinematics of movements in the error-clamp block and found that, as movements became more similar to subjects' natural movements in the perturbation block, the lag to decay onset became longer and eventually reached hundreds of trials. Furthermore, when there was decay in the motor output, the endpoint of decay was not zero but a fraction of the motor memory that was last acquired. Therefore, adaptation to a perturbation installed two distinct kinds of memories: (1) one that was disengaged when the brain detected a change in the task and (2) one that persisted despite it. Motor memories showed little decay in the absence of error if the brain was prevented from detecting a change in task conditions.

Pharmaceutical care in paediatric intensive care unit: activities and interdisciplinary learning in a Spanish hospital

ObjectiveTo describe and quantify the clinical and logistic activities of a resident pharmacist in a paediatric intensive care unit (PICU) and to identify the key areas for improvements in training.MethodsA...

Pharmaceutical intervention assessment in critically ill patients

BackgroundPatients admitted to the intensive care unit (ICU) are exposed to medication errors twice as compared to other hospital units. Pharmaceutical care in critically ill patients may increase the quality...

Simulations of BAO reconstruction with a quasar Ly-αsurvey

The imprint of Baryonic Acoustic Oscillations (BAO) on the matter power spectrum can be constrained using the neutral hydrogen density in the intergalactic medium as a tracer of the matter density. One of the goals of the Baryon Oscillation Spectroscopic Survey (BOSS) of the Sloan Digital Sky Survey (SDSS-III) is to derive the Hubble expansion rate and the angular scale from the BAO signal in the IGM. To this aim, the Lyman-alpha forest of 10^5 quasars will be observed in the redshift range 2.2<z<3.5 and over 10,000 deg^2. We simulated the BOSS QSO survey to estimate the statistical accuracy on the BAO scale determination provided by such a large scale survey. In particular, we discuss the effect of the poorly constrained estimate of the unabsorbed intrinsic quasar spectrum. The volume of current N-body simulations being too small for such studies, we resorted to Gaussian random field (GRF) simulations. We validated the use of GRFs by comparing the output of GRF simulations with that of the Horizon N-body simulation with the same initial conditions. Realistic mock samples of QSO Lyman-\alpha forest were generated; their power spectrum was computed and fitted to obtain the BAO scale. The rms of the results for 100 different simulations provides an estimate of the statistical error expected from the BOSS survey. We confirm the results from Fisher matrix estimate. In the absence of error on the unabsorbed quasar spectrum, the BOSS quasar survey should measure the BAO scale with an error of the order of 2.3%, or the transverse and radial BAO scales separately with errors of the order of 6.8% and 3.9%, respectively. The significance of the BAO detection is assessed by an average \Delta\chi^2=17 but for individual realizations \Delta\chi^2 ranges from 2 t o 35. The error on the unabsorbed quasar spectrum increases the error on the BAO scale by 10 to 20% and results in a sub percent bias.

Barriers to Adverse Event and Error Reporting in Anesthesia

Although anesthesiologists are leaders in patient safety, there has been little research on factors affecting their reporting of adverse events and errors. First, we explored the attitudinal/emotional factors influencing reporting of an unspecified adverse event caused by error. Second, we used a between-groups study design to ask whether there are different perceived barriers to reporting a case of anaphylaxis caused by an error compared with anaphylaxis not caused by error. Finally, we examined strategies that anesthesiologists believe would facilitate reporting. Where possible, we contrasted our results with published findings from other physician groups. An anonymous, self-administered, mailed survey was conducted of 629 consultant anesthesiologists and 263 anesthesiology residents on the mailing list of the Australian and New Zealand College of Anaesthetists in Victoria, Australia. Participants were randomized into "Error" versus "No Error" groups for the specified anaphylaxis adverse event section of the survey. Data were analyzed using nonparametric descriptive and inferential tests. There were 433 usable returned surveys, a usable response rate of 49%. First, there was only 1 of 13 statements on attitudinal/emotional factors that influenced reporting of an unspecified adverse event caused by error with which more anesthesiologists agreed/strongly agreed than disagreed/strongly disagreed: "Doctors who make errors are blamed by their colleagues." Second, when an error rather than no error had caused anaphylaxis, participants were more likely to agree/strongly agree that 6 statements about litigation, getting into trouble, disciplinary action, being blamed, unsupportive colleagues, and not wanting the case discussed in meetings, were perceived as reporting barriers. Finally, the most favored assistive strategies for reporting were generalized deidentified feedback about adverse event and error reports, role models such as senior colleagues who openly encourage reporting, and legislated protection of reports from legal discoverability. The majority of anesthesiologists in our study did not agree that the attitudinal/emotional barriers surveyed would influence reporting of an unspecified adverse event caused by error, with the exception of the barrier of being concerned about blame by colleagues. The probable influence of 6 perceived barriers to reporting a specified adverse event of anaphylaxis differed with the presence or absence of error. Anesthesiologists in our study supported assistive reporting strategies. There seem to be some differences between our results and previously published research for other physician groups.

THE IMPACT OF POINT‐OF‐SALE DATA INACCURACY AND INVENTORY RECORD DATA ERRORS

The presence or absence of error in point‐of‐sale (POS) data and inventory system records directly affects retailer performance. This study identifies various error sources in retail supply chains and studies the influence of inventory and POS (demand) errors in a simulated retail outlet according to fill rate and average inventory. Other things being equal, we find that inventory record error reduces fill rate more than demand error. This study adds further evidence to other studies that suggest the costs caused by errors in POS systems may be overstated.

Beyond sequential presentation: Misconceptions and misrepresentations of sequential lineups

Malpass, Tredoux, and McQuiston-Surrett (2009), hereinafter ‘MTM’, provide comments on the sequential lineup, research comparing sequential and simultaneous lineups, and the policy implications of this literature. We will comment on points of agreement and disagreement. First, we agree with the following: (1) Peer review, publication of results, and diversity of methods, procedures, and subject populations significantly contribute to the value of research as a basis both for psychological understanding and for recommended policy. (2) Absence of error, omission, and confounds make interpretation and application easier. These conclusions are not revolutionary but seem to occupy a great deal of MTM’s thinking. We disagree with many things that MTM have to say but have room here only to address a few.

Estimation of population mean when coefficient of variation is known using scrambled response technique

The objective of this paper is to suggest estimators for population mean μ x in the presence of scrambled responses when (i) the coefficient of variation (CV) C x of X is known in absence of error, (ii) when the guessed value C x 0 of the coefficient of variation C x of X is available. The merits of the suggested estimators have been examined through numerical illustrations.

Secondary and Tertiary Citing: A Study of Referencing Behavior in the Literature of Citation Analysis Deriving from the Ortega Hypothesis of Cole and Cole

This study examines a complex network of documents and citations relating to the literature of the Ortega Hypothesis (as defined by Jonathan R. Cole and Stephen Cole), demonstrating the tenacity of errors in details of and meaning attributed to individual citations. These errors provide evidence that secondary and tertiary citing occurs in the literature that assesses individual influence through the use of citations. Secondary and tertiary citing is defined as the inclusion of a citation in a reference list without examining the document being cited. The authors suggest that, in the absence of error, it is difficult to determine the amount of secondary and tertiary citing considered normative. Therefore, to increase understanding of the relationship between citations and patterns of influence, it is recommended that large-scale studies examine additional instances of citation error.

Physical mapping of chromosomes using unique probes.

The goal of physical mapping of the genome is to reconstruct a strand of DNA given a collection of overlapping fragments, or clones, from the strand. We present several algorithms to infer how the clones overlap, given data about each clone. We focus on data used to map human chromosomes 21 and Y, in which relatively short substrings, or probes, are extracted from the ends of clones. The substrings are long enough to be unique with high probability. The data we are given is an incidence matrix of clones and probes. In the absence of error, the correct placement can be found easily using a PQ-tree. The data are never free from error, however, and algorithms are differentiated by their performance in the presence of errors. We approach errors from two angles: by detecting and removing them, and by using algorithms that are robust in the presence of errors. We have also developed a strategy to recover noiseless data through an interactive process that detects anomalies in the data and retests questionable entries in the incidence matrix of clones and probes. We evaluate the effectiveness of our algorithms empirically, using simulated data as well as real data from human chromosome 21.