Incorrect Instructions Research Articles

FP6.7 - Assessing knowledge and effective utilisation of incentive spirometer across surgical floor

Abstract Aim to assess the level of knowledge of healthcare workers providing incentive spirometer and instruction provided to patient. Methods Snapshot audit between 25&28/05/23 assessing the knowledge and practice using two for patient and staff questionnaires. Inclusions criteria were all adult patients in surgical wards, all healthcare staff. Exclusion criteria were patients who did not receive a spirometer and patients or staff who were not willing to participate in the study. Results 75% of staff provided incentive spirometers, 84% of them never received formal education or training in the use of incentive spirometer. Only one staff member (1.85%) answered all the questions correctly. 83% of patients were not given the correct instructions and approximately 16% were instructed to exhale. Implemented Changes A video created with e-link; explaining the use of incentive spirometer. Training of medical and nursing staff by presenting the project in our local departmental meeting, the results and poster emailed to health professionals. A new patient leaflet was created containing clear instructions, the video link, and a table to record their usage. Random sampling showed significant improvement. The Second cycle will be conducted at beginning of the new year and the results will be presented at the conference Conclusion The lack of training led to incorrect instructions being given to patients. This could lead to false reassurance to the senior medical staff, by assuming that patients are using spirometers correctly which could delay recovery and discharge. Simple training has resulted in significant increase in knowledge and correct use of a spirometer. Checking the staff knowledge is recommended, especially in common daily practice

Large language models for preventing medication direction errors in online pharmacies

Errors in pharmacy medication directions, such as incorrect instructions for dosage or frequency, can increase patient safety risk substantially by raising the chances of adverse drug events. This study explores how integrating domain knowledge with large language models (LLMs)—capable of sophisticated text interpretation and generation—can reduce these errors. We introduce MEDIC (medication direction copilot), a system that emulates the reasoning of pharmacists by prioritizing precise communication of core clinical components of a prescription, such as dosage and frequency. It fine-tunes a first-generation LLM using 1,000 expert-annotated and augmented directions from Amazon Pharmacy to extract the core components and assembles them into complete directions using pharmacy logic and safety guardrails. We compared MEDIC against two LLM-based benchmarks: one leveraging 1.5 million medication directions and the other using state-of-the-art LLMs. On 1,200 expert-reviewed prescriptions, the two benchmarks respectively recorded 1.51 (confidence interval (CI) 1.03, 2.31) and 4.38 (CI 3.13, 6.64) times more near-miss events—errors caught and corrected before reaching the patient—than MEDIC. Additionally, we tested MEDIC by deploying within the production system of an online pharmacy, and during this experimental period, it reduced near-miss events by 33% (CI 26%, 40%). This study shows that LLMs, with domain expertise and safeguards, improve the accuracy and efficiency of pharmacy operations.

Make Modern Microbiology Matter More in the 2023 European Society of Cardiology Guidelines for the Management of Infective Endocarditis.

The European Society of Cardiology (ESC) 2023 guidelines for the management of infective endocarditis (IE) stress that a multidisciplinary approach is needed to manage patients with IE. In our view, the guidelines do not include the relevant perspectives from modern microbiology. The diagnostic criteria for IE were changed in the ESC 2023 guidelines, and many IE-causing pathogens are either not clearly defined. Moreover, an improved understanding of the relationship between bacterial species and the risk for IE has not been implemented. The guidelines give detailed and, in our view, incorrect instructions about diagnostic testing in blood culture-negative IE without presenting proper evidence. Other important diagnostic aspects, such as the value of repeated blood cultures and incubation time for blood cultures, are not discussed. We believe that a multidisciplinary collaboration that include microbiologists would have improved these guidelines, and we hope for a future harmonization of diagnostic criteria for IE.

Uçak Kazalarında İletişim Hatalarının Payı ve Havacılıkta İletişim Odaklı Geliştirilebilecek Yapay Zekâlar

In the history of civil aviation, there have been many fatal accidents due to different reasons. Most of the accidents occurred as a result of human error. Especially for the accidents that occur as a result of malfunctions in the aircraft engine or the systems on the aircraft, a large amount of accidents have been prevented by making use of new technologies. Despite these, accidents caused by human error continue to exist today. Aircraft accidents caused by communication errors are especially important. Due to misunderstanding, misinformation about flight rules, giving incorrect instructions, misunderstanding or misinformation as a result of not having sufficient command of the language used and not providing the necessary information, communication errors occur and as a result, fatal plane crashes occur. In addition to human errors in communication, problems may occur due to the systems used. In particular, the old radio systems used and the problems that occur during the transmission of data also cause accidents. For the same reasons, it is necessary to develop new technologies and use them in the aviation industry in order to avoid accidents. Since the number of people working in the sector cannot be reduced to zero, these technologies should be used and human error should be minimized.
 the purpose of this research; It is to examine and determine the share of aircraft accidents caused by communication errors and to examine the artificial intelligence that can be used in the subject. In the study, the 20 deadliest plane crashes in the history of civil aviation were examined. In addition, the example of Tenerife District is given because it is related to the subject. According to the information obtained as a result of the study, it was determined that 7 of the 20 deadliest accidents in the history of civil aviation were caused by communication errors. Within the framework of the study, Correlation Analysis was conducted to determine the degree of relationship between the number of deaths in accidents and the causes of accidents.

Self-Supervised Skill Learning for Semi-Supervised Long-Horizon Instruction Following

Language as an abstraction for hierarchical agents is promising to solve compositional long-time horizon decision-making tasks. The learning of the agent poses significant challenges, as it typically requires plenty of trajectories annotated with languages. This paper addresses the challenge of learning such an agent under the scarcity of language annotations. One approach for leveraging unannotated data is to generate pseudo-labels for unannotated trajectories using sparse seed annotations. However, as the scenes of the environment and tasks assigned to the agent are diverse, the inference of language instructions is sometimes incorrect, causing the policy to learn to ground incorrect instructions to actions. In this work, we propose a self-supervised language-conditioned hierarchical skill policy (SLHSP) which utilizes unannotated data to learn reusable and general task-related skills to facilitate learning from sparse annotations. We demonstrate that the SLHSP that learned with less than 10% of annotated trajectories has a comparable performance to one that learned with 100% of annotated data. Our approach to the challenging ALFRED benchmark leads to a notable improvement in the success rate over a strong baseline also optimized for sparsely annotated data.

Principles for Minimizing Errors in Examination Papers and Other Educational Assessment Instruments

Errors in examination papers and other assessment instruments can compromise fairness. For example, a history question containing an incorrect historical date could be impossible for students to answer. Incorrect instructions at the start of an examination could lead students to answer the wrong number of questions. As there is little research on this issue within the educational assessment community, we reviewed the literature on minimizing errors in other industries and domains, including aviation, energy, and medicine. We identified generalizable principles and applied them to our context of educational assessment. We argue that since assessment instrument construction is a complex system comprising numerous interacting components, a holistic approach to system improvement is required. Assessment instrument errors stem primarily from human failure. When human failure occurs, it is not good enough to suggest that ‘to err is simply human’. Instead it is necessary to look deeper, evaluating the latent working conditions that underpin the efficacy of procedures, making the human failure more or less likely. Drawing from the aviation industry’s ergonomic SHELLO model, we articulate and explore three of the most critical working conditions that relate to our context: (i) time pressure, (ii) workload and stress, and (iii) wider organizational culture, including good error data collection. We conclude with recommendations for best practice in minimizing errors in assessment instruments. A ‘good’ error culture should be promoted, which avoids blaming individuals. Errors should be acknowledged readily by all, and system owners should take a scientific approach to understanding and learning from them.

Incidence of dispensing errors before and after root cause analysis at Sanglah General Hospital, Denpasar

Background and purpose: Drug dispensing errors have a major impact on the incidence of medication errors, and can be very dangerous to patients and affect the quality of care. Root cause analysis (RCA) is an approach to prevent dispensing errors by identifying the root of the problem, make efforts to improve comprehensively across departments so that incidence of dispensing errors are not repeated. The purpose of this study is to determine the differences in the incidence of dispensing errors before and after the RCA.Methods: This is a descriptive study by calculating the incidence of dispensing errors before and after the RCA, conducted in four inpatient wards at Sanglah Hospital Denpasar. Dispensing errors were categorized into ten types namely errors in drug’s identity, name, dosage, number of drugs, absence of high alert labels, incorrect drug preparations, incorrect strength, expired drugs, incorrect place of delivery and incorrect instructions. In February and April 2018 there were 80 and 40 dispensing errors which met the study criteria, respectively.Results: Crude incidence of dispensing errors before and after RCA were 2.54 per 1000 (95%CI: 1.98-3.10) and 1.26 per 1000 (95%CI: 0.87-1.65), respectively. The decrease in dispensing error after RCA was 50.39%. The ratio of dispensing error incidence rates after and before the RCA is 0.49. Significant decrease in the incidence of dispensing errors was only found in drug identity errors of 1.27 per 1000 (95%CI: 0.88-1.66) before an RCA and 0.06 per 1000 (95%CI: -0.03-0.15) after RCA, or decreased by 95.27% and there was no significant decrease in other dispensing errors.Conclusion: The decrease of dispensing errors after the RCA was only found in the medication identity error and not found in the other dispensing errors. Direct observation and intensive supervision are needed in order to accurately calculate and reduce the incidence of dispensing errors.

Incidence of dispensing errors before and after root cause analysis at Sanglah General Hospital, Denpasar

Background and purpose: Drug dispensing errors have a major impact on the incidence of medication errors, and can be very dangerous to patients and affect the quality of care. Root cause analysis (RCA) is an approach to prevent dispensing errors by identifying the root of the problem, make efforts to improve comprehensively across departments so that incidence of dispensing errors are not repeated. The purpose of this study is to determine the differences in the incidence of dispensing errors before and after the RCA. Methods: This is a descriptive study by calculating the incidence of dispensing errors before and after the RCA, conducted in four inpatient wards at Sanglah Hospital Denpasar. Dispensing errors were categorized into ten types namely errors in drug’s identity, name, dosage, number of drugs, absence of high alert labels, incorrect drug preparations, incorrect strength, expired drugs, incorrect place of delivery and incorrect instructions. In February and April 2018 there were 80 and 40 dispensing errors which met the study criteria, respectively. Results: Crude incidence of dispensing errors before and after RCA were 2.54 per 1000 (95%CI: 1.98-3.10) and 1.26 per 1000 (95%CI: 0.87-1.65), respectively. The decrease in dispensing error after RCA was 50.39%. The ratio of dispensing error incidence rates after and before the RCA is 0.49. Significant decrease in the incidence of dispensing errors was only found in drug identity errors of 1.27 per 1000 (95%CI: 0.88-1.66) before an RCA and 0.06 per 1000 (95%CI: -0.03-0.15) after RCA, or decreased by 95.27% and there was no significant decrease in other dispensing errors. Conclusion: The decrease of dispensing errors after the RCA was only found in the medication identity error and not found in the other dispensing errors. Direct observation and intensive supervision are needed in order to accurately calculate and reduce the incidence of dispensing errors.

Identifying Medical Equipment Usability Issues from Social Media Reports

Traditional methods of investigating usability include usability tests, heuristic evaluations, surveys, and field methods. User self-reports of equipment problems such as through the FDA MAUDE database are also available, but there may be limited information reported. Often, people turn to social media to share stories and learn from others. In this study, the authors explored using social media as a means of identifying possible usability issues with medical devices and products. As a proof of concept, the authors focused on insulin pumps, continuous glucose monitors, and sleep apnea machines. Reports of medical equipment use issues were grouped into three categories: 1) correct instructions for product use, 2) apparently inadvertent incorrect instructions for use and 3) instructions that encouraged or could promote deliberate misuse. Each of these has different implications for designers, clinical product review committee members, and clinicians.

Patient Perspectives on Causes of Suboptimal Bowel Preparation for Screening Colonoscopies: A Qualitative Study

Introduction: Current guidelines favor screening for colorectal cancer with colonoscopy, but 10-30% of patients have suboptimal bowel-preparation (prep.) precluding colonoscopy completion. This study aims to identify causes of suboptimal prep. using patient's perspective. Methods: A qualitative cross-sectional study with semi-structured interviews was performed at an academic high-volume endoscopy center with open access provider referrals. Physicians conducted telephone interviews with patients who had suboptimal prep. using an interview guide. Domains covered were pre-procedural instructional material, actual prep. process, perceived reasons for poor prep, and patient opinions on repeat colonoscopies. Interviews were analyzed using a qualitative thematic analysis. Results: Thematic saturation was reached after interviewing 20 patients (Table 1). Nine patients (45%) received incorrect instructions, incurred errors included wrong prep. duration (standard versus extended prep.), incorrect dietary instruction, contradictory or inadequate instructions from different providers, and prescription mistakes. There was no standardization in delivering instruction materials to patients. A paucity of patients received a reminder phone call prior to the colonoscopy, although many patients had pre-procedural questions or concerns. Non-compliance was present only in a minority of cases. Patients who had received the correct mailed instructions from providers thought the instructions were generally clear and well-understood, but a few patients had difficulty understanding the timing of the extended prep. Demographics including educational level and insurance were representative of our patient population. Patients underwent either one-day or two-day golytely prep.; no patients were instructed to undergo split-dose prep. Conclusion: Several etiologies of suboptimal prep. were identified. Deficient or incorrect instruction material is a modifiable system error that could be remedied by enforcing standardized delivery of verbal and written instructions. Endoscopy centers with open access referrals may experience more prep-instruction errors due to inaccurate information from outside providers. Most patients demonstrated insight into their errors including diet or medications changes or suboptimal prep.; many were motivated to amend this in a future colonoscopy. Qualitative analysis of patient perspectives can serve as a valuable quality improvement tool for screening colonoscopies.

Incomplete and incorrect epinephrine auto-injector training to food-allergic patients by pharmacists in the Netherlands.

Successful treatment of anaphylaxis in the community relies on early and correct use of epinephrine auto-injectors (EAI). In the Netherlands, pharmacists supply EAIs to patients and have a crucial role in instructing patients in how and when to use EAI. However, there are currently no data in Europe on the quality of such instruction provided by pharmacists. Therefore, the aims of this study were to investigate the knowledge, attitudes, and beliefs regarding food allergy among pharmacists in the Netherlands and to investigate the quality of EAI instructions and demonstrations to patients by pharmacists. Pharmacists were asked to complete an online questionnaire. Quality of instructions and demonstration accuracy were assessed in mystery guest visits to randomly selected pharmacies. For the statistical analysis, descriptive methods were used. In total, 25 of 115 questionnaires were completed. Only two (8%) respondents gave correct answers concerning the proper EAI demonstration. Twenty-one (84%) respondents thought that the provision of instructions was the responsibility of pharmacists. In total, ten pharmacies were included in simulated patient visits. Five of them (50%) demonstrated the EAI. None of them demonstrated the EAI use correctly. Food-allergic patients at high risk for anaphylaxis who receive their EAI from a community pharmacy are often not instructed on how to use an EAI or receive incorrect instructions. Pharmacists show considerable gaps in knowledge about food allergy and its management. These data suggest that opportunities exist to improve the quality of care provided by pharmacies to high-risk food-allergic patients.

Importance of Correct Instructions in the Tetrad Test

Use of the tetrad test has increased recently as both theoretical and experimental results have shown that it is statistically more powerful than the triangle test. In this article, although, we show that this power advantage depends on the choice of instructions. Specifically, we show that if experimenters ask respondents to select the two most similar samples out of four, instead of asking respondents to group the four samples into two groups of two based on similarity, then the resulting test will have approximately the same power as the triangle test. This fact serves as a reminder of the importance of correct test instructions in difference testing, as specific wording can clearly affect a test power and thus the final conclusion of an investigation. Practical Applications Businesses are increasingly considering the tetrad test as an alternative to the triangle test within their difference testing programs. This article clarifies the correct test instructions for the tetrad test, and shows that its power advantage over the triangle test will be compromised if incorrect instructions are given. Thus, it is essential that practitioners provide correct task instructions in order to realize the full potential of the tetrad test.

AThurstonian Analysis of theTwo‐Out‐of‐Five Test

AbstractTheTwo‐Out‐of‐Five test is a method of unspecified difference testing. Although its low guessing probability (1/10) gives promise that it might have high power, the theoretical underpinnings of the method have not yet been investigated. In this article, we offer the first such investigation, viaThurstonian analysis. This investigation reveals that the standard form of theTwo‐Out‐of‐Five test is more statistically powerful than theTriangle test, but not as powerful as theTetrad test. We then propose a new way of scoringTwo‐Out‐of‐Five data that yields a test with higher power and lower sample size requirements than theTetrad test, under the assumption that there is no additional noise from the evaluation of an additional stimulus. This last result is achieved without any experimental modification of theTwo‐Out‐of‐Five protocol. Tables for estimating theThurstonian measure of sensory effect size,δ, for calculating the error in such estimates, and for recommended sample sizes are given. Finally, caution is given against incorrect instructions in theTwo‐Out‐of‐Five test – if respondents are asked simply to identify the two most similar samples, the resulting test has almost no power.Practical ApplicationsThis article shows that the standard form of theTwo‐Out‐of‐Five test is more powerful than theTriangle test, but is not as powerful as theTetrad test. The article then proposes a new method of scoringTwo‐Out‐of‐Five data that requires smaller sample sizes than theTetrad test, under the assumption that the evaluation of an additional stimulus does not lead to an increase in perceptual noise. When this alternate method of scoring the data is used, the test is called theTwo‐Out‐of‐Five test with forgiveness. Tables for estimatingδ, theThurstonian measure of sensory difference, together withBvalues that allow practitioners to calculate the variance in their estimates are given for both forms of theTwo‐Out‐of‐Five test. Tables of recommended sample sizes are also given in each case. Finally, it is noted that care must be taken to give correct instructions to respondents – it is possible to create a test with very low power if respondents are simply asked to identify the two most similar stimuli.

The role of work environment in keeping newly licensed RNs in nursing: A questionnaire survey

BackgroundIn prior studies, newly licensed registered nurses (RNs) describe their job as being stressful. Little is known about how their perceptions of the hospital work environment affect their commitment to nursing. ObjectivesTo assess the influence of hospital work environment on newly licensed RN's commitment to nursing and intent to leave nursing. DesignCorrelational survey. SettingsNewly licensed RNs working in hospitals in Florida, United States. Participants40% random sample of all RNs newly licensed in 2006. MethodsThe survey was mailed out in 2008. Dependent variables were indicators of professional commitment and intent to leave nursing. Independent variables were individual, organizational, and work environment characteristics and perceptions (job difficulty, job demands and job control). Statistical analysis used ordinary least squares regressions. Level of significance was set at p<0.05. ResultsJob difficulty and job demand were significantly related to a lower commitment to nursing and a greater intent to leave nursing, and vice versa for job control. The strongest ranked of the job difficulties items were: incorrect instructions, organizational rules, lack of supervisor support, and inadequate help from others. Workload and other items were significant, but ranked lower. The strongest ranked of the job pressure items were: “having no time to get things done” and “having to do more than can be done well.” The strongest ranked of job control items were “ability to act independent of others.” Nurses with positive orientation experiences and those working the day shift and more hours were less likely to intend to leave nursing and more likely to be committed to nursing. Significant demographic characteristics related to professional commitment were race and health. ConclusionsNegative perceptions of the work environment were strong predictors of intent to leave nursing and a lower commitment to nursing among newly licensed RNs. These results indicate that retention of newly licensed RNs in nursing can be improved through changes in the work environment that remove obstacles to care-giving, increase resources and autonomy, and reduce workload and other job pressure factors.

Perceived causes of prescribing errors by junior doctors in hospital inpatients: a study from the PROTECT programme

IntroductionPrescribing errors are a major cause of patient safety incidents. Understanding the underlying factors is essential in developing interventions to address this problem. This study aimed to investigate the perceived...

Reported Endoscope Reprocessing Breaches, Minnesota, 2010-2011

Background/Objectives: Endoscopic diagnostics and therapeutics increasingly are replacing invasive surgical procedures and are being performed in ambulatory and inpatient settings. Cleaning and disinfection of endoscopes and their accessories is complex and must be performed according to U. S. Food and Drug Administration (FDA) labeling and manufacturer instructions. Breaches in endoscope reprocessing can expose patients to viral and bacterial pathogens andmust be addressed on a case-by-case basis. Infection preventionists (IPs) play a fundamental role in identifying and investigating such breaches. State health departments have an expanding role in healthcare-associated infection prevention and consultation separate from regulatory functions. We discuss a state health department infectious disease epidemiology program's experience of providing public health consultation to guide the investigation of endoscope reprocessing breaches. Methods: Over the past 18 months, IPs from several healthcare facilities requested assistance after identifying incidents of inadequate endoscope reprocessing. In each situation, IPs collected information on the nature of the breach, facility type, clinical practices, endoscope/endoscopic accessories used, and cleaning/ disinfection procedures. In consultation with Centers for Disease Control and Prevention (CDC), the risk to patients, including pathogen transmission, was evaluated. Interventions such as patient notification, internal facility communication, and FDA notification were assessed and implemented as appropriate. Results: From 5/2010-9/2011, 7 endoscope reprocessing breaches were reported from 5 healthcare facilities (1 clinic, 1 ambulatory surgical center, 3 hospitals) and involved various endoscope types (upper GI endoscope [3], cystoscope [1], hysteroscope [1], colonoscope [1], transesophageal echocardiography scope [1]). Breaches were recognized by technicians (blood in the scope after reprocessing, scope occlusion due to broken accessory piece) or by IPs (cluster of bacterial infections post-endoscopic procedure, observation/audit of technician practices). These incidents resulted from incorrect use of endoscopic accessories, reprocessing of single use devices, or failure to follow FDA labeling and/or manufacturer reprocessing instructions. Four breaches were reported to FDA because the manufacturer and/or vendor representative provided incorrect instructions. To assist future breaches, we developed an endoscope breach assessment tool and list of resources. Conclusions: IPs associated with healthcare facilities where endoscopic procedures are performed should be familiar with national endoscope reprocessing guidelines. Reprocessing protocols and procedures must be assessed regularly, particularly when implementing equipment or procedure changes, and all staff involved with endoscopic procedures and/or reprocessing must receive regular education, training, and competency testing. State health departments should also be aware of national endoscope reprocessing guidelines and other resources in order to assist healthcare facilities in investigating breaches, including notifying patients, and reporting to FDA. IPs should be aware that the

Double Dutch: The ‘think-aloud’ Brief IPQ study uses a Dutch translation with confusing wording and the wrong instructions

This commentary describes the methodological shortcomings and the misleading presentation of the 'think-aloud' Brief Illness Perception Questionnaire (IPQ) paper by van Oort, Schröder, & French (2011). We highlight that this paper uses a confusing Dutch translation of the scale, fabricates incorrect instructions, and employs a sample in which the majority of patients do not have established illness diagnoses. We believe these problematic methodological issues are the likely cause of the results presented in the paper. We argue that the conclusions of the paper are inaccurate, unsupported, and overstated given the limitations of the study. Furthermore, the think-aloud method cannot be a substitute for the established psychometric methods for assessing reliability and validity.

Successful introduction of artesunate combination therapy is not enough to fight malaria: results from an adherence study in Sierra Leone

A study to measure adherence to artesunate and amodiaquine (AS+AQ) therapy in patients treated for uncomplicated malaria in community health centres (CHC) was conducted in Sierra Leone. Patients/caretakers were interviewed and remaining AS+AQ tablets at home after the last treatment dose were counted. Persons leaving CHCs with an AS+AQ prescription were also interviewed (exit interviews). In total, 118 patients were visited at home: 27 (22.9%) had one or more tablets left and were classed as certainly non-adherent; 34 (28.8%) were probably non-adherent [reported incorrect ( n = 27) or incomplete ( n = 7) intake]; and 57 (48.3%) were probably adherent. The main reasons for incomplete intake were sickness after one dose of AS+AQ, no food available for drug intake and forgetting to take them. For incorrect intake, reasons were vomiting after drug intake and incorrect instructions given by the CHC. Eighty-one percent of probably adherent patients reported following instructions given to them. In exit interviews, 82% of patients or caretakers of patients were able to repeat AS+AQ intake instructions correctly. Adherence to antimalarial treatment should not be taken for granted. Instructions on correct AS+AQ use should include discussion of disease symptoms as well as possible treatment side effects and how to manage them. Other factors are more difficult to influence, such as patients forgetting to take the treatment.

Avaliando a interação de instruções e comportamento supersticioso em esquemas concorrentes

O objetivo do presente estudo foi avaliar a interação entre instruções e comportamento supersticioso em um componente Ext de um esquema conc VI Ext. Participantes, estudantes do ensino médio, receberam instruções corretas ou incorretas antes das sessões. Nas instruções corretas, os participantes eram informados que deveriam responder a apenas um dos componentes do esquema concorrente; nas incorretas, que deveriam responder aos dois componentes. Antes e depois das sessões eram feitas perguntas sobre o que os participantes deveriam fazer durante as sessões. Quatro dos sete participantes responderam nos componentes Ext e VI por pelo menos uma sessão. Análise das frequências mostrou que três desses quatro participantes responderam em Ext durante toda a sessão. O responder supersticioso (responder consistente em Ext) dependeu do quanto as instruções ou as contingências não verbais geraram variabilidade no responder no início das sessões.Palavras-chave: comportamento supersticioso; instruções; esquemas concorrentes.

Missed opportunities for participation in prevention of mother to child transmission programmes: Simplicity of nevirapine does not necessarily lead to optimal uptake, a qualitative study

BackgroundThe objective of this study was to examine missed opportunities for participation in a prevention of mother-to-child transmission (PMTCT) programme in three sites in South Africa. A rapid anthropological assessment was used to collect in-depth data from 58 HIV-positive women who were enrolled in a larger cohort study to assess mother-to-child HIV transmission. Semi-structured interviews were conducted with the women in order to gain an understanding of their experiences of antenatal care and to identify missed opportunities for participation in PMTCT.Results15 women actually missed their nevirapine not because of stigma and ignorance but because of health systems failures. Six were not tested for HIV during antenatal care. Two were tested but did not receive their results. Seven were tested and received their results, but did not receive nevirapine. Health Systems failure for these programme leakages ranged from non-availability of counselors, supplies such as HIV test kits, consent forms, health staff giving the women incorrect instructions about when to take the tablet and health staff not supplying the women with the tablet to take.ConclusionHIV testing enables access to PMTCT interventions and should therefore be strengthened. The single dose nevirapine regimen is simple to implement but the all or nothing nature of the regimen may result in many missed opportunities. A short course dual or triple drug regimen could increase the effectiveness of PMTCT programmes.