Clerical Errors Research Articles

Challenges in transfusion microbiology.

Transfusion microbiology must minimize the risks of transfusion transmitted infection (TTI) in a cost-effective and efficient manner. The wide range of transmissible microbial agents exhibits different relative risks in different circumstances; therefore, the same safety rules are not always applicable. TTIs can also exist as asymptomatic diseases in their hosts, so donors must be screened for high-risk behavior. Then blood must be screened by detecting antibodies to infectious agents. Since antibody reactivity is difficult to confirm, and cross-reactive or nonspecific effects are possible, a reactive sample can be tested by a range of assays, each based on a different immunoassay principle, or by a supplementary assay. Despite the advanced nature of these tests, problems of indeterminate donors remain, and a compromise must be made between the sensitivity and specificity of screening assays; maximum sensitivity protects transfusion recipients, but specificity prevents wasting blood or making false reports about donor health. An ideal screening assay would have maximum sensitivity, optimal specificity, simplicity, objectivity, standard format, rapid processing time, safety of reagents, and economy. Assay users must chose the best combination of available characteristics for their particular situation. For example, a French study found that 30% of seronegative, but HIV-infectious, donors are anti-HBc positive; this test would be too specific, however, in a country where hepatitis B is common. Combined assays are being used to screen for anti-HIV-1 and -2 and anti-human T-cell lymphotropic virus-I and -II; this should save time and money. Screening donors selectively (for example, Latin American migrants to North America for Trypanosoma cruzi) may protect previously unexposed populations. In some countries, transmission of HIV via seronegative blood is a problem, and HIV antigen screening and confirmation of reactivity by neutralization should occur as soon as reagents become less expensive. As test methodology continues to move through rapid developmental "generations," the development of sensitive techniques to detect nucleic acids holds promise. Several problems will remain to be solved including cost cross-contamination and carry-over in automated sampling systems, and operational and clerical errors. While there are methods to inactivate viruses in plasma pools, inactivation must incur a minimal loss of biological activity. All of these challenges are exacerbated in developing countries by a lack of resources. As physicians become knowledgeable about when to use transfusion and when to use an alternative method, such as blood salvage, refusing transfusion will be more risky than contracting a TTI.

Hematologic emergencies

Two hematologic emergencies are reviewed in this article: transfusion reactions and crises in patients who have sickle cell disease. Transfusion reactions may be due to incompatibility, IgA deficiency, allergy or, rarely, bacterial contamination of the blood product. A major hemolytic reaction due to incompatibility may progress to hypotension and shock. To prevent this type of reaction, blood products should be given only when necessary and attention should be given to eliminating clerical errors, which are responsible for many hemolytic reactions. In patients with sickle cell disease, a painful crisis due to vascular occlusion is the most common emergency. Rehydration is essential, and narcotics may be needed to relieve pain. Aplastic crisis is managed by transfusion of packed red blood cells and supportive care. Sickle cell crisis may affect major organ systems. The acute chest syndrome can be complicated by pneumonia; rapid respiratory failure may occur if multiple lobes are involved. Splenic or hepatic sequestration requires aggressive rehydration and transfusion. In patients who have had stroke or subarachnoid hemorrhage, a long-term exchange transfusion program is needed to keep hemoglobin S levels below 30%.

A symbolic algorithm for studying adjustments to the profile likelihood

A symbolic algorithm for the derivation of the asymptotic expansion of the maximum likelihood estimate was first introduced by Andrews & Stafford (1993). This algorithm is quite general and can be modified to give asymptotic expansions for the maximum likelihood estimate based on either the conditional, modified or adjusted profile likelihoods. Expansions are obtained quickly with no chance for human clerical error. As a result, these three adjustments can be easily studied and some new statistical results are obtained. Bartlett corrections of each adjusted likelihood, and asymptotic expansions for the first four moments of the maximum likelihood estimate based on the conditional and adjusted profile likelihoods, are derived.

Accrual Accounting, Modified Cash Basis of Accounting and the Loan Decision: An Experiment in Functional Fixation

The paper presents the results of an empirical study in which bank loan officers evaluated a loan application which were accompanied by financial statements based on either accrual accounting or modified cash basis of accounting (MCBOA). The loan officers first decided whether to grant the loan and determined an interest rale. Second, they evaluated the financial statements information on the basis of three quality attributes: Overall reliability, freedom from clerical errors and freedom from the effects of fraud. The results verified a functional fixation hypothesis by showing that the loan officers examining the financial statements of the same company using either accrual information or MCBOA showed clear preference for the company when faced with accrual information. A conditioning factor is used to explain the results.

The effect of flow rate upon the magnitude of the olfactory response differs for different odorants

The authors wish to bring to your attention that the values given in Table II for stimulus volume, which are listed in cm3 in the column headed by V, were clerically misstated and did not agree with the values given in the text. None of the other values in the article or any of its reported findings and interpretations were affected by this clerical error. The correct values for this column from top to bottom should have read in cm3 as follows: 0.405, 0.70, 1.28, 2.20, 0.405, 0.70, 1.28, 2.20, 0.405, 0.70, 1.28, 2.20, 0.405, 0.70, 1.28, 2.20, 0.405, 0.70, 1.28, 2.20, 0.405, 0.70, 1.28, 2.20.

Identification of previous erythrocyte alloimmunization and the type and screen at a large cancer center. A 4-year retrospective review

A review of 4 years of hemolytic transfusion reactions and evidence for erythrocyte alloimmunization (RBC-A) was conducted from September 1, 1985 to August 31, 1989 to assess retrospectively the safety of pretransfusion testing using the type and screen (T & S) with immediate-spin crossmatch (IS-XM). All transfusion reaction reports were reviewed for reported "possible hemolytic transfusion reaction" and RBC-A, as identified by the reviewing pathologist. Three hemolytic transfusion reactions (HTR) and eight RBC-A were found for the 4 years. During the review period, 92,759 units of packed RBC were transfused to 22,317 patients. Of these, 76,257 (82.2%) units of packed RBC had IS-XM, 12,414 (13.4%) had an antiglobulin crossmatch, and 4088 (4.4%) were issued without crossmatch. Of the immediate reactions, two were caused by clerical errors, and one was of undetermined cause. The eight RBC-A were discovered during subsequent pretransfusion testing in the Transfusion Service and classified as anamnestic responses to prior transfusions or pregnancies. The eight RBC-A were attributed to the following antibodies: three anti-Jka, one anti-E, one anti-FYa plus unidentified antibody, one anti-Fya, one anti-Jkb, and one anti-Fy3. The low rate of HTR and prior RBC-A detected posttransfusionally in a large cancer center such as this may be used to support the conclusion that the use of T & S with IS-XM is a reasonably safe procedure.

LEP compact 10 immunohaematology analyser overview of performance

The Compact 10 has been developed in a collaborative study between Lep Scientific and the Bristol Blood Transfusion Service. The analyser represents state of the art micro-continuous flow cytometry with advanced software support. This makes the Compact 10 the only fully automated "set and walk away" immunohaematology instrument available with the capability to perform both blood group and antibody screen. It is currently in routine operation in more than thirty major hospitals and transfusion laboratories in Europe. During 1990 it was estimated that the existing Compact 10's had grouped in excess of 5 million samples with a "group not determined" (GND) rate of less than 5%. It's size and throughput make the analyser ideally suited to both large transfusion service and hospital blood banks alike. The accuracy of testing is guaranteed by the machine readable specimen labels eliminating the chance of clerical error. The combination of advanced continuous flow and software control makes mistakes in blood group reporting impossible. The economy of the Compact 10 is outstanding. The consumption of antisera is less than <i>2%</i> of that used in established manual serological techniques. Another critical feature of the Compact 10 is its safety. The analyser's "closed system" ensures total protection of laboratory workers from the risk of infection. The combination of the Compact 10's economy, reliability, safety and efficiency make it an attractive proposition for any clinical laboratory.

Literal versus Metaphorical Interpretations of Scale Terms: A Serendipitous Natural Experiment

Due to a clerical error, a teaching evaluation form used in a psychology department during Fall, 1990, combined a grading format with opinion items. Course evaluations on the incongruous form were compared with evaluations of the same courses taught by the same instructors using a consistent opinion format. Results for individual instructors, courses, and items were similar on the two administrations, supporting the view that the terms used in teaching evaluation scales are interpreted metaphorically rather than literally.

Continuous improvement-I

Continuous improvement, one of the panaceas currently in good currency, is an integral and important part of Total Quality Management (TQM). No one, of course, can oppose improvement, let alone continuous improvement. Unfortunately, however, what is called "continuous improvement" frequently isn't. In fact, it may hurt performance. Continuous improvement begins by examining a current activity, process, product, or service and determining what is wrong with it. It focuses on weaknesses such as clerical errors, product defects, late deliveries, and so on. Improvement is conceptualized primarily as the removal of defects or deficiencies. Unfortunately, the removal of defects and deficiencies provides no assurance of reaching an end point that is more desirable than the point at which one starts. This is apparent from the following examples. If I turn on a TV set in the middle of a weekday, there is a very low probability that the program that initially appears is one that I want. This is a defect that I can easily remove by changing the channel. However, there is still a very low probability that I will get a program I want, and in fact, I may well get one I like even less. On occasion I may go through as many as ten channels without getting a program I want. Thus, the "solut ion," changing the channel, is not necessarily a solution. Moreover, it does not attack the underlying problem, which is the paucity of programs that I would like to see. Recall what happened in the United States when it tried to get rid of the deficiency, alcoholism, by eliminating what it took to be its cause, alcohol. "Prohibition" did not eliminate either alcohol or alcoholism but it did produce large-scale organized crime. In the 1960s the United States tried to eliminate drug addiction similarly, by illegalizing all addictive drugs. Again, the solution intensified the problem rather than solved it and it gave organized crime an even

An Analysis of Cases Incorrectly Coded as Inflammatory Bowel Disease in Scottish Hospital In-Patient Statistics (Ships)

As part of a large clinical and epidemiological study of inflammatory bowel disease (IBD), we examined the hospital case records of a sample (255) of the 1257 patients aged 0-20 years, recorded in Scottish Hospital In-Patient Statistics (SHIPS) for 1968-1983 as Crohn's disease (CD) or ulcerative colitis (UC). The coded diagnosis was incorrect at the time of coding in 47 instances (18.4% of the sample), for the following reasons: clinical diagnosis wrong (24 cases); IBD correctly diagnosed but wrongly coded as CD for UC or UC for CD (seven cases): various other clerical or computer errors (15 cases). One case that did not meet standard diagnostic criteria for CD at the time of coding was shown to be correctly labelled when confirmatory pathological information became available. In view of the influence of such statistics on the social and clinical management of chronic illnesses such as IBD, and in view of the impact of analysis of these data on the provision of services and allocation of resources, it is suggested that some indication of the degree of confidence in the clinical diagnosis (possible, probable, definite) should be incorporated in the information submitted for coding and should be reflected in the derived data.

Reasons for Changing Answers: An Evaluation Using Personal Interviews

Researchers investigating answer changing have consistently found the preponderance of changes on objective items to be from wrong to right, but little is understood about the mechanisms involved in this phenomenon. In this study, personal interviews were combined with instruction in answer‐changing research to investigate further the processes involved in answer changing. Students changed answers and gained from changing, with those in the upper two thirds of the classes gaining the most. Each test‐taking strategy produced a mean gain, but particular strategies were not significantly correlated with percentage of gain or percentage of change. Most students reported changing answers for thoughtful reasons such as rereading, rethinking, or remembering more information; very few changes were due to clerical errors. For each reason, most changes were wrong‐to‐right. We conclude that reconsideration of test items is probably underestimated in answer‐changing studies. The role of memory should be considered in why people change and in how successful they judge their changing to have been.

Research in Physical Medicine and Rehabilitation

This paper describes important aspects of preliminary data analysis to be taken after data are checked for clerical entry errors and before the primary statistical analysis is performed. These include description and graphic display of each variable, recoding categorical data, transforming continuous data into another continuous variable and recording continuous to categorical data. Missing values and outlying data points are identified and several techniques are recommended to minimize mistakes in variable recording. Related variables measured with different units may be combined by using the z transformation and converted back to one of the original units for ease of interpretation. Finally, both categorical and continuous variables are checked for reliability by using kappa or the intraclass R.

Intraplate seismicity of the Pacific Basin, 1913?1988

We establish here a comprehensive database of intraplate seismicity in the Pacific Basin. Relocation and analysis of 894 earthquakes yield 403 reliable intraplate earthquakes during 1913–1988. These numbers do not include earthquake swarms, which account for another 838 events. Most of the remainder (304 events) are actually plate boundary earthquakes that have been erroneously located in intraplate regions. A significant number occur in recent years when location capabilities should have guarded against this situation. Relocations involve a careful linear inversion of P and S arrivals, accompanied by a Monte Carlo statistical analysis. We have also attentively removed the high number of clerical errors and nuclear tests that exist in epicenter bulletins.

Procedural errors in antibody identification

Abstract In experimental studies of students and line technologists performing antibody identification procedures, both groups made errors. These errors included, at times, either failing to identify an antibody or misidentifying the specificity(ies). A prospective study was undertaken to identify errors made in a laboratory setting. Errors were classified as 1) failing to follow protocol (procedural error) or 2) arriving at the wrong answer (misidentification error). Over a 1-year period, 1,057 workups were reviewed. There were 41 (3.88%) procedural errors and no misidentification errors. In 25 workups (61% of errors), the selection of cells to rule out underlying alioantibody(ies) was in error. The remaining 16 involved various “slips” (minor mistakes or memory lapses) and clerical errors. Based on an analysis of the probable causes of these errors, potential solutions include 1) developing computer aids to detect “rule-out” errors or missing tests results; 2) providing timely, carefill review of workups before transfusion; and 3) designing better panel layout and cell selection. Immunohematology 1991;1:20–22.

Research in Physical Medicine and Rehabilitation

This paper describes important aspects of preliminary data analysis to be taken after data are checked for clerical entry errors and before the primary statistical analysis is performed. These include description and graphic display of each variable, recoding categorical data, transforming continuous data into another continuous variable and recoding continuous to categorical data. Missing values and outlying data points are identified and several techniques are recommended to minimize mistakes in variable recoding. Related variables measured with different units may be combined by using the z transformation and converted back to one of the original units for ease of interpretation. Finally, both categorical and continuous variables are checked for reliability by using kappa or the intraclass R.

Hemolysis caused by half‐physiologic‐strength saline

TransfusionVolume 30, Issue 1 p. 78-78 Hemolysis caused by half-physiologic-strength saline J.P. Whitelaw MDCM, FRCP(C), J.P. Whitelaw MDCM, FRCP(C)Search for more papers by this author J.P. Whitelaw MDCM, FRCP(C), J.P. Whitelaw MDCM, FRCP(C)Search for more papers by this author First published: January 1990 https://doi.org/10.1046/j.1537-2995.1990.30190117641.xCitations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume30, Issue1January 1990Pages 78-78 RelatedInformation

Analytic Reviews : Hemolytic Transfusion Reactions: A Review of Mechanisms, Sequelae, and Management

The transfusion of blood and blood products is an im portant therapeutic procedure, but it is associated with several potentially serious adverse effects. Among these complications are hemalytic reactions, which in most cases result from the interaction between donor red cell antigens and recipient plasma antibodies. Clinical mani festations and sequelae are largely determined by the physical and immunological characteristics of the anti gens and antibodies. Early recognition may be difficult in the anesthetized or intensively monitored patient. Acute hemolytic reactions are responsible for significant morbidity and mortality and may lead to life-threatening shock, disseminated intravascular coagulation, and renal failure. Fortunately, fatal hemolytic transfusion reactions are rare; they usually result from clerical errors. Proper diagnosis and management requires sound clinical judg ment, thorough laboratory investigation, and timely therapeutic intervention.

Rapid Determination of Egg Weight and Specific Gravity Using a Computerized Data Collection System

A rapid data-collection system for determining egg weight and specific gravity is described. The method links a microcomputer and an electronic balance to facilitate specific gravity determination by the displaced water (CADW) or Archimedes’ method. Measurements obtained by this technique were compared with those determined by the saline flotation method. Repeatability measures showed both methods to be relatively precise. The CADW method was faster and reduced opportunities for clerical error.

Radiation Myelopathy: A Review: Medical and Pediatric Oncology, vol. 15, no. 2, 1987, pp. 89–95

Radiation myelopathy is a serious potential complication associated with radiation therapy to the spinal cord. Its exact cause is unknown. It represents a spectrum of syndromes, the most common of which are acute transient radiation myelopathy and chronic progressive radiation myelitis. A review of the literature indicates that cord damage is related to a number of controllable factors including dose fraction size, treatment time, total dose, length of cord irradiated, technical and clerical errors. Other less well understood factors that appear to contribute to the risk such as combined chemoradiotherapy effects and hyperthermia should also be recognized. A better awareness and understanding of these factors should ultimately lead to safer and more effective treatments.

Research Note: Improved Efficiency of Egg Collection and Data Analysis Using TRS-80 Model 100 Portable Computer

A software program for recording production data directly into a small, hand-held, battery-operated computer is described. The advantage of the computerized egg production data collection and analysis is an overall savings in labor and a reduction of clerical errors. Time required for statistical analysis and summary of results is significantly reduced. The system’s main component is a small, portable, battery-operated, programmable, hand-held computer.