Avoidable Errors Research Articles

A peer teaching module for medical residents on critical appraisal of medical articles: context and pilot testing

BackgroundThe ability of healthcare providers to access and use published research correctly is crucial for the quality of healthcare services, enabling selection of the most effective treatment modalities, and avoidance of medical errors. Physicians need strong critical appraisal (CA) skills to manage rapidly evolving medical knowledge.MethodsA standard peer-teaching module was prepared for medical residents on CA. The module included topic-specific educational materials, discussion articles, and question sets and was pilot-tested among medical residents, allowing for revisions based on participants’ feedback. Training module was prepared by a senior epidemiologist and a community medicine (public health) resident, based on the context of a similar graduate course; the resident underwent four months of personal training preceding the pilot testing, which was conducted as a 12-week program in September-November 2023, supervised by experts. Online training extended our reach to resident working nationwide. Recruitment was enabled via social media and various medical specialty organizations. Evaluations included initial, session-specific, and final tests for measuring progress in knowledge on CA, based on participants’ self-assessments, and external auditors’ scoring of the process.ResultsA total of 52 residents from 19 universities and nine specialty programs participated in pilot testing. Of these, 48 completed the program through the post-test, with 83% (n = 40) scoring above 65%, received a certificate of achievement. Median scores showed a 32% increase in knowledge, a 75% increase in confidence in CA skills, and a 50% decrease in stress-related to CA practice. Additionally, 82.5% (n = 33) of those who completed the module expressed interest in offering similar training sessions to their local peers.ConclusionThe online peer teaching of the CA module successfully increased participants’ knowledge and self-confidence in critical appraisal.Clinical trial numberNot applicable.

Enhancing safe medication use in home care: insights from informal caregivers.

To investigate the factors influencing medication errors made by informal caregivers while providing care at home. A cross-sectional study based on an online survey, which included both structured and open-ended questions, was conducted in Spain. The survey comprised 49 questions to collect self-reported avoidable medication errors made by caregivers at home. A total of 685 caregivers participated in the survey, with 346 considered qualified (having received >20 h of training). On average, 13.5 (SD 38.2, 95% CI 10.5-16.5) errors per caregiver per year were self-reported. Errors were more prevalent among non-qualified caregivers, males, direct relatives of the care recipient, those with external occupations, or those who used external aids. Errors made by informal caregivers occur more frequently than expected, and recognizing these errors remains a challenge. Training is essential for creating safer care environments by increasing awareness of error sources and the risks associated with medication. Recipients' direct relatives should receive appropriate training, considering differences between male and female caregivers. Associations and companies within the care economy sector should prioritize the creation of safer home care environments as a key objective.

VSPIM: SRAM Processing-in-Memory DNN Acceleration via Vector-Scalar Operations

Processing-in-Memory (PIM) has been widely explored for accelerating data-intensive machine learning computation that mainly consists of general-matrix-multiplication (GEMM), by mitigating the burden of data movements and exploiting the ultra-high memory parallelism. The two mainstreams of PIM, the analog- and digital-type, have both been exploited in accelerating machine learning workloads by numerous outstanding prior works. Currently, the digital-PIM is increasingly favored due to the broader computing support and the avoidance of errors caused by intrinsic non-idealities, e.g., process variation. Nevertheless, it still lacks further optimization considering the characteristics of the GEMM computation, including better efficient data layout and scheduling, and the ability to handle the sparsity of activations at the bit-level. To boost the performance and efficiency of digital SRAM PIM, we propose the architecture called VSPIM that performs the computation in a bit-serial fashion, with unique support of vector-scalar computing pattern. The novelties of the VSPIM can be concluded as follows: 1) support bit-serial based scalar-vector computing via ingenious parallel bit-broadcasting; 2) refine the GEMM mapping strategy and computing pattern to enhance performance and efficiency; 3) powered by the introduced scalar-vector operation, the bit-sparsity of activation is leveraged to halt unnecessary computation to maximize efficiency and throughput. Our comprehensive evaluation shows that, compared to the state-of-the-art SRAM-based digital-PIM design (Neural Cache), VSPIM can significantly boost the performance and energy efficiency by up to <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"><tex-math notation="LaTeX">$8.87\times$</tex-math></inline-formula> and <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"><tex-math notation="LaTeX">$4.81\times$</tex-math></inline-formula> respectively, with negligible area overhead, upon multiple representative neural networks.

Recognizing and preventing unacknowledged prescribing errors associated with polypharmacy

BackgroundPrescribing errors put an enormous burden on health and the economy, claiming implementation of effective methods to prevent/reduce them. Polypharmacy regimens (five or more drugs) are highly prone to unacknowledged prescribing errors, since the complex network of drug-drug interactions, guidelines and contraindications is challenging to be adequately evaluated in the prescription phase, especially if different doctors are involved. Clinical decision support systems aimed at polypharmacy evaluation may be crucial to recognize and correct prescribing errors.MethodsA commercial clinical decision support system (Drug-PIN®) was applied to estimate the frequency of unrecognized prescribing errors in a group of 307 consecutive patients accessing the hospital pre-admission service of the Sant’Andrea Hospital of Rome, Italy, in the period April-June 2023. Drug-PIN® is a two-step system, first scoring the risk (low, moderate or high) associated with a certain therapy-patient pair, then allowing therapy optimization by medications exchanges. We defined prescribing errors as cases where therapy optimization could achieve consistent reduction of the Drug-PIN® calculated risk.ResultsPolypharmacy was present in 205 patients, and moderate to high risk for medication harm was predicted by Drug-PIN® in 91 patients (29.6%). In 58 of them (63.7%), Drug-PIN® guided optimization of the therapy could be achieved, with a statistically significant reduction of the calculated therapy-associated risk score. Patients whose therapy cannot be improved have a statistically significant higher number of used drugs. Considering the overall study population, the rate of avoidable prescribing errors was 18.89%.ConclusionsResults suggest that computer-aided evaluation of medication-associated harm could be a valuable and actionable tool to identify and prevent prescribing errors in polypharmacy. We conducted the study in a Hospital pre-admission setting, which is not representative of the general population but represents a hotspot to intercept fragile population, where a consistent fraction of potentially harmful polypharmacy regimens could be promptly identified and corrected by systematic use of adequate clinical decision support tools.

Child Migrants in Family Detention in the US: Addressing Fragmented Care.

Migrant children in family detention facilities often experience frequent relocations and prolonged stays in precarious living conditions. This frequent relocation results in fragmentation of necessary medical care, leading to delays and inadequate medical care. We aim to highlight the critical need for comprehensive medical documentation in immigration detention facilities, a fragmented health care system and potential harm to these children without appropriate medical documentation. We conducted a retrospective review of 165 medical records from children detained at the Karnes County Family Residential Center between June 2018 and October 2020 to evaluate the adequacy of pediatric medical documentation in an Immigration and Customs Enforcement (ICE) family detention facility. Specific areas of interest included acute care, nutrition, immunization, developmental screening, and tuberculosis screening. Simple descriptive statistics were used to analyze the data. Only 25% of 418 acute medical care visits included specific diagnoses. There was no documentation regarding follow-up recommendations upon release. 97% of children had a chest X-ray completed for tuberculosis screening, however no follow-up recommendations were documented for those with granulomas. Vaccination histories were inconsistently documented. No nutritional categorizations were completed despite 16% of children being at risk for malnutrition or already malnourished. Our findings revealed significant gaps in documentation, particularly in medical decision-making and clinical reasoning. In a fragmented medical system, inadequate documentation can result in avoidable errors in diagnosis and management. Improving documentation practices is crucial to ensure that all children, regardless of immigration status, receive quality healthcare aligned with national and international standards.

Culpability and Prediction in Medical Error

According to the World Health Organization (2023), 2.6 million people die annually due to preventable adverse events in hospitals. This data is still underestimated, as the study evaluated only 150 countries. Each year, out of the 19.4 million people treated in hospitals in Brazil, 1.3 million experience at least one side effect caused by negligence or recklessness during medical treatment. In 2021, the Federal Council of Medicine reported that 92% of colleges do not meet at least one of the three parameters deemed ideal for the proper operation of medical courses. Every hour, three medical error lawsuits (The National Justice Council states that 3 medical error lawsuits are filed every hour) are filed in Brazil, and medical culpability finds practical and doctrinal differences at civil and criminal levels. The implementation of evidence-based medicine can reduce the numbers indicated and to this end, supported by the medical literature, the practitioner has the opportunity to contain the error and, as a consequence, the accounting of deaths and unexpected events using the exact science for that. The research thus recommends strategies to reduce avoidable errors and calls for stricter penalties for gross error.

A Prospective Look at the Prevalence of Setup Electrode-Swap Errors Across Over 450 Intraoperative Neuromonitoring Cases

ABSTRACT Intraoperative neurophysiological monitoring (IONM) is shown to be useful in surgeries when the nervous system is at risk. Its success in part relies upon proper setup of often dozens of electrodes correctly placed and secured upon patients and inserted in specific stimulating and recording receptacles. Given the complicated setups and the demanding operating room environment, errors in setup are bound to occur. These have led to false negatives associated with new patient morbidities including, at times, paralysis. No studies quantify the prevalence of these types of setup errors. Approximately 800,000 operations annually utilize intraoperative neuromonitoring in the US alone, so even a small percentage of errors suggests clinical significance. In addition, these types of errors hinder the overall effectiveness of IONM and may result in lower reported sensitivities and lower cost-effectiveness of this important service. We sought to discover through a prospective study and verification through chart review the prevalence of “electrode-swap” errors (when recording and/or stimulating electrodes are incorrectly placed on the patient or in the IONM equipment during setup) across all procedures monitored. We found recording and/or stimulating electrode set up errors in 24 of 454 cases (5.3%). These data and examples of how errors were discovered intraoperatively are reported. We also offer techniques to help reduce this error rate. This study demonstrates a significant potential avoidable error in IONM diagnostic utility, patient outcome, and sensitivity/specificity of alert criteria. The value of identifying and correcting these errors is consequential, multifaceted, and far-reaching.

Inference of neutron-star properties with unified crust-core equations of state for parameter estimation

Context. Relating different global neutron-star (NS) properties, such as tidal deformability and radius, or mass and radius, requires an equation of state (EoS). Determining the NS EoS is therefore not only the science goal of a variety of observational projects, but it also enters in the analysis process; for example, to predict a NS radius from a measured tidal deformability via gravitational waves (GW) during the inspiral of a binary NS merger. To this aim, it is important to estimate the theoretical uncertainties on the EoS, one of which is the possible bias coming from an inconsistent treatment of the low-density region; that is, the use of a so called non-unified NS crust. Aims. We propose a numerical tool allowing the user to consistently match a nuclear-physics informed crust to an arbitrary high-density EoS describing the core of the star. Methods. We introduce an inversion procedure of the EoS close to saturation density that allows users to extract nuclear-matter parameters and extend the EoS to lower densities in a consistent way. For the treatment of inhomogeneous matter in the crust, a standard approach based on the compressible liquid-drop (CLD) model approach was used in our work. A Bayesian analysis using a parametric agnostic EoS representation in the high-density region is also presented in order to quantify the uncertainties induced by an inconsistent treatment of the crust. Results. We show that the use of a fixed, realistic-but-inconsistent model for the crust causes small but avoidable errors in the estimation of global NS properties and leads to an underestimation of the uncertainties in the inference of NS properties. Conclusions. Our results highlight the importance of employing a consistent EoS in inference schemes. The numerical tool that we developed to reconstruct such a thermodynamically consistent EoS, CUTER, has been tested and validated for use by the astrophysical community.

Design and Development of Electronic Moulage of Brachial Plexus Muscles to Enhance the Learning of Upper Limb Anatomy: An Interventional Study

Background: Anatomy embraces various fields and is regarded as the foundation of medical sciences due to its broad clinical applications, particularly in surgery. However, teaching this subject, particularly in practical units, poses challenges, and insufficient anatomical knowledge and errors in anatomy-related decisions by physicians can lead to avoidable deaths and medical errors. This study aimed to design and develop an electronic moulage (EM) for teaching upper limb anatomy, specifically focusing on the muscles and brachial plexus (BP). Methods: This was a quasi-experimental study with a pre-test-post-test design. Electronic moulage has been implemented in a manner that allows independent structures within a compartment to be taught without the presence of a teacher or anatomical atlases and enables learners to comprehend the anatomical features and relationships of structures in both combined and isolated modes, even without prior knowledge of anatomical theory specific to that compartment. The EM incorporates a skeletal compartment system and a BP component, utilizing audio and visual systems to deliver a comprehensive educational experience. The effectiveness of the EM was evaluated by experts in anatomy and medical science students, comparing it to other teaching methods. Four groups of undergraduate medical radiology students with no prior instruction in upper limb anatomy participated in the study. Each group was assigned to a different training method, including lecture-based education, digital-based education with a simulator, cadaver-based education, and EM-based education. Results: After assessing the results using educational and motivational indicators, it was determined that the EM demonstrated innovative potential and could enhance motivation and the quality of anatomy education. Comparing the post-test scores of the EM-based education group to the other groups revealed significantly higher scores in the EM-based group. This finding indicates that the EM has the potential to improve the effectiveness and efficiency of anatomy education, addressing the limitations of other teaching methods. Conclusions: The developed EM presents a promising solution for enhancing anatomy education, particularly in the context of upper limb anatomy. The innovative features of EM and its ability to improve motivation and learning outcomes make it a valuable tool for teaching this subject matter.

Time-optimal Point-to-point Motion Planning: A Two-stage Approach

This paper proposes a two-stage approach to formulate the time-optimal point-to-point motion planning problem, involving a first stage with a fixed time grid and a second stage with a variable time grid. The proposed approach brings benefits through its straightforward optimal control problem formulation with a fixed and low number of control steps for manageable computational complexity and the avoidance of interpolation errors associated with time scaling, especially when aiming to reach a distant goal. Additionally, an asynchronous nonlinear model predictive control (NMPC) update scheme is integrated with this two-stage approach to address delayed and fluctuating computation times, facilitating online replanning. The effectiveness of the proposed two-stage approach and NMPC implementation is demonstrated through numerical examples centered on autonomous navigation with collision avoidance.

Sugestões de uma equipe de saúde hospitalar à formação e ao preparo profissional para pandemias

ABSTRACT Introduction: The COVID-19 pandemic provided evidence of gaps in the preparation of health professionals. The objective of this study was to know the suggestions of professionals who worked in healthcare about how to better prepare them to deal with this context. Method: This was an exploratory qualitative study with in-depth semi-structured interviews of diverse groups of professionals from a high-complexity teaching hospital in the South Region of Brazil. Comprehensive Sociology was used as a framework. Results: The suggestions for institutions that provide healthcare included greater attention to their clinical staff, with regularly offered technical training and psychological preparation programs. Suggestions for health education institutions included greater curricular emphasis on psychological aspects and comprehensive care in human health, with humanization; communication; collaborative teamwork, leadership, and management; greater theoretical and practical course load, with simulation and practice in real emergency and intensive care scenarios, in addition to contents covering crisis medicine, biosafety, bioethics when resources are scarce, and care for critically-ill patients. Discussion: The literature indicates that investments in permanent education programs minimize avoidable errors, improve team performance and promote professional development. In the context of the Covid-19 pandemic, the need to learn self-care, communication with patients and family members and strategies for controlling and managing emotions was highlighted. With regard to technical and scientific skills to be emphasized in the presence of mass crises, topics related to biosafety and care for critically-ill patients are highlighted. Final considerations: The suggestions provided can contribute to better preparation of health professionals to work in pandemic contexts.

Teaching Grammar as Meaning-Making in the Writing Class: An Inclusive Approach

This article addresses the question of how teachers can adopt an inclusive approach to the teaching of grammar that attends to the diverse language learning abilities of students in an English Language(EL)writing class. This article suggests that teaching grammar as a meaning-making resource in an EL writing class empowers students of various language learning abilities to make meaningful grammatical choices in their writing. Teaching grammar as a meaning-making resource entails adopting a descriptive view of grammar. This is as opposed to adopting a prescriptive view of grammar where the avoidance or remediation of errors in writing is the emphasis. Two primary school EL teachers engaged in an action research project in a primary school in Singapore on teaching grammar as a meaning-making resource within writing in the EL classroom were interviewed. Three strategies on how to teach grammar as a meaning-making resource in writing were identified. The three strategies are a) visualisation of links between grammar and writing, b) discussion of grammatical choices in writing and c) provision of clear feedback on grammar in writing. In teaching grammar this way, students of varying language learning abilities are empowered to make grammatical choices in creating meaning in writing.

A Knowledge, Attitude, and Practice (KAP) Study on Phlebotomy Among Nurses in a Tertiary Hospital in Patna, India.

For most clinicians and nursing officers, laboratory testing is an unfamiliar part of medical caregiving, and ignorance may lead to serious avoidable errors. Phlebotomy, the first basic step towards laboratory testing, is to be taken seriously otherwise unnecessary repeat testing becomes mandatory. We hypothesized that there are some gaps in knowledge, attitude, and practice (KAP) among these nursing officers regarding practices of phlebotomy, which may influence the quality of blood samples. This study aims to assess the overall nurses' knowledge, attitude, and practice of phlebotomy to provide a remarkable improvement in blood sampling practice in our hospital. A prospective study was conducted involving nurses posted in different wards in All India Institute of Medical Sciences (AIIMS) Patna, India. A phlebotomy questionnaire was designed based on KAP on the clinical and laboratory standards of the WHO guidelines. A total of 30 questions were distributed among the nursing staff, 10 each from knowledge, attitude, and practice. Descriptive and logistic regression analyses were used to analyze the KAP levels and their influencing factors.All continuous variables were tested for normality conditions using the Shapiro-Wilk test and P>0.05 were considered for normality. The total average score of knowledge among the nurses was 7.62 (95%CI: 15.77-16.56). It was found that the nurses, on average, had a very strong positive attitude (93.36%). Regarding the distribution of practices of nurses, it was found that 87% had good practice as most of the positive practice items had high responses. The knowledge of phlebotomy among nurses was found to be satisfactory, except in a few areas. An education program on phlebotomy should be developed for nurses to improve and enhance their knowledge of phlebotomy.

Why is it Interesting to Study the Duration of the Relationship (Review of the Auditor and the Subject) Auditor: Audited Entity?

The integrity and impartiality of the reports issued by the external auditors makes the main attention to focus on their role, because they are the persons responsible for discovering the presence of errors or frauds in the financial reports of the audited entity. We are talking about the external auditors, who are the independent professionals who must give their opinion through a report on the truthfulness, sincerity and honesty of the picture presented by the audited entity's financial statements. In relation to the role they have in the fight against corruption, the scientific research method used in this study is through questionnaires as a tool for collecting data and closely touching the awareness of the main actors on their integrity. These interviews were conducted with a sampling that represents the auditors. A total of 9 questions were conducted in order to strengthen and validate the results for our research question. The results of this study suggest that auditors' awareness of the role and importance of their integrity is key to the audit process, but there are some risks that may harm the quality of the audit and the auditor's independence, or the risk of developing complacency. The quality of the audit is positively related to the integrity of the financial reports of the audited entities and negatively related to the risk of "falling prey" of the auditors themselves. The increase in the quality of information reduces the asymmetry affecting the detection and avoidance of errors and consequently affects the increase in the quality of the audit, (F. Hakim, Omri &amp; I. Hakim, 2010, p. 152). Audit quality is related to the ability of auditors to identify material anomalies in financial statements as well as their willingness to issue an unbiased and appropriate audit report (Turley &amp; Willekens, 2008, p. 3).&#x0D; &#x0D; Received: 14 September 2023 / Accepted: 27 October 2023 / Published: 23 November 2023

Simple and User-Friendly Methodology for Crystal Water Determination by Quantitative Proton NMR Spectroscopy in Deuterium Oxide.

In drug research and development, knowledge of the precise structure of an active ingredient is crucial. However, it is equally important to know the water content of the drug molecule, particularly the number of crystal waters present in its structure. Such knowledge ensures the avoidance of drug dosage and formulation errors since the number of water molecules affects the physicochemical and pharmaceutical properties of the molecule. Several methods have been used for crystal water measurements of organic compounds, of which thermogravimetry and crystallography may be the most common ones. To the best of our knowledge, solution-state NMR spectroscopy has not been used for crystal water determination in deuterium oxide. Quantitative NMR (qNMR) method will be presented in the paper with a comparison of single-crystal X-ray diffraction and thermogravimetric analysis results. The qNMR method for water content measurement is straightforward, reproducible, and accurate, including measurement of 1H NMR spectrum before and after the addition of the analyte compound, and the result can be calculated after integration of the reference compound, analyte, and HDO signals using the given equation. In practical terms, there is no need for weighing the samples under study, which makes it simple and is a clear advantage to the current determination methods. In addition, the crystal structures of two model bisphosphonates used herein are reported: that of monopotassium etidronate dihydrate and monosodium zoledronate trihydrate.

Collision probability reduction method for tracking control in automatic docking/berthing using reinforcement learning

Automation of berthing maneuvers in shipping is a pressing issue as the berthing maneuver is one of the most stressful tasks seafarers undertake. Berthing control problems are often tackled by tracking a predefined trajectory or path. Maintaining a tracking error of zero under an uncertain environment is impossible; the tracking controller is nonetheless required to bring vessels close to desired berths. The tracking controller must prioritize the avoidance of tracking errors that may cause collisions with obstacles. This paper proposes a training method based on reinforcement learning for a trajectory tracking controller that reduces the probability of collisions with static obstacles. Via numerical simulations, we show that the proposed method reduces the probability of collisions during berthing maneuvers. Furthermore, this paper shows the tracking performance in a model experiment.

Assessing the Capacity for Change Prior to the Adoption of Human Factors Engineering in Power Plant Maintenance

Even in the epoch of the 4th Industrial Revolution, technologies are introducing human–machine/technology interactions that must be appropriately managed to prevent or reduce avoidable human errors. In recent years, power plants have started examining ways to manage human errors attributable to maintenance, thereby improving performance, safety, and well-being. Maintenance management requires the integration of human factors engineering (HFE) principles with maintenance practices to handle the issue of human errors. When adopting human factors engineering interventions to enhance maintenance, power plants must demonstrate the capacity for change to ensure effective management of change and realize the intervention’s benefits. The main focus in power plants is usually on the technical side of change, with less emphasis on human factors. This study aimed to develop and trial a model for determining the capacity for change to aid HFE adoption in electric power systems maintenance. A quantitative and cross-sectional survey was conducted with maintenance personnel working in South African power plants. The results showed that management commitment, knowledge, and employee involvement are associated with the capacity for change in the maintenance of power plants. This study extends previous studies on the capacity for change when adopting unconventional interventions in maintenance such as HFE principles.

Investigation of Nurses' Wellbeing towards Errors in Clinical Practice-The Role of Resilience.

Background and Objectives: The fatigue, stress, and burnout of nurses lead to them frequently making mistakes, which have a negative impact not only on the safety of the patients but also on their psychology. The ability to bounce back from mistakes is crucial for nurses. Nursing staff members' physical and mental health, particularly their depression, is far from ideal, and this ill health is directly correlated with the frequency of self-reported medical errors. The nurses' mental and physical health are also positively correlated with their perception of wellness support at work. This cross-sectional study aimed to investigate the status of nurses' mental and physical health regarding clinical errors and the impact of resilience on coping with these situations. Materials and Methods: A total of 364 healthcare professionals participated in this research; 87.5% of them were females and 12.5% of them were males. Most of the participants were 22-35 years old. The median number of years of employment was nine. Clinical nurses anonymously and voluntarily completed a special structured questionnaire that included questions from different validated tools in order to assess their state of physical and mental wellbeing after events of stress and errors made during their practice. Results: In total, 49.4% of the nurses had made an error on their own, and 73.2% had witnessed an error that someone else had made. At the time of the error, 29.9% of the participants were in charge of more than 20 patients, while 28.9% were responsible for a maximum of three patients. Participants who were 36-45 years old had more resilience (p = 0.049) and experienced fewer negative emotions than participants who were 22-35 years old. The participants who mentioned more positive feelings according to their mental state had greater resilience (p > 0.001). Conclusions: Errors were likely to happen during clinical practice due to nurses' negative experiences. The level of resilience among the nursing population was found to play a very important role not only in making mistakes but also in coping with errors during their daily routine. Wellness and prevention must be given top priority in all healthcare systems across the country in order to promote nurses' optimal health and wellbeing, raise the standard of care, and reduce the likelihood of expensive, avoidable medical errors. Healthcare administrations should promote prevention programs for stress occurrence in order to support nurses' wellbeing maintenance.

Best practices in reporting analyses of questionnaires as objective rating scales of variable measures.

The best practice model states that the highest quality of scientific information in a discipline should be used when addressing pertinent problems. The usefulness of any measure depends on the least allowable error, which implies that best practice approaches must be used during analyses of rating scales. However, modern theories of objective measurement in advanced statistics suggest there are some shortcomings in reports of questionnaire analyses. To highlight some common problems in questionnaire data and suggest techniques of constructing objective measures during rating scale analysis. Questionnaires are frequently used as rating scales of latent variables, such as knowledge, anxiety and outcomes of treatments. However, reports of the steps involved before generating the final 'measures' often fail to present known limitations and robust solutions to the problems common to questionnaire data. Most designers of questionnaires generate variable measures for either educational or clinical research purposes without providing adequate explanations of the steps taken to address inherent limitations that may worsen the error terms in the outcome measure. Cursory attention is given to the problems in questionnaire analysis as most users do not convincingly justify the measurement techniques they used before they present variable estimation. Reporting the techniques used to address data complexity by engaging objective measurement parameters ensures best practice and emphasises the credibility of the outcome measure. Among researchers, using the techniques outlined here will lead to standardisation of questionnaire analysis and elimination of avoidable errors in constructing variable measures, resulting in high-quality data suitable for parametric statistics. For clinicians, these methods will simplify the interpretation of numerical measures to equivalent indicators on Wright maps, thus avoiding inconsistencies and misinterpretations of variable measure.

Investigating the Use of Online Bilingual Resources by Translation Students: The Vertical/Sequential Model Revisited

Four experiments were carried out in a university translation course after noticing the recurrence of specific errors identical in most target texts produced by students. The purpose was, to identify the errors and verify whether they could be attributed to using online bilingual resources before comprehension of the source text, and, second, to implement a teaching strategy for addressing this problem and later assess its effectiveness. Participants in the study were twenty-seven female students in two groups registered for the course in two semesters: a group in one semester and the other in the following term. They translated two experimental texts from English L2 into Arabic L1. Each text was translated twice: the first time by one group at the beginning of their course, where students were allowed to access all types of resources, and the second by the other group towards the end of their course, after implementation of the teaching strategy. Comparison between the target texts produced before the implementation of the strategy and those made following the strategy reveals that the latter category contained f fewer translation errors -regrouped in the study as inappropriate renderings, with almost no occurrence of the type termed excessive literality. The findings suggest that the use of bilingual resources by translation students before full-text comprehension is the main cause of most otherwise avoidable errors. Consequently, it should be banned at the first phase of the translation process. The teaching strategy, based on the vertical/sequential translating model, is recommended in translation teaching.