Safety Professionals Research Articles

Patient safety culture through the lenses of surgical patients: a qualitative study

BackgroundPatient engagement and learning from patients’ experiences may increase patient safety and reduce the occurrence of adverse events. Most adverse events are related to surgery, and patient outcomes are positively associated with patient safety culture. This study aimed to explore former surgical patients’ perspectives and experiences of adverse events and patient safety culture during their surgical pathway and identify themes relevant to adverse event causes and quality improvement projects.MethodsThe design of this qualitative study was explorative, utilizing an abductive approach. We purposefully recruited former surgical patients from Norwegian user organizations based on group characteristics sampling. The participants were 57% men and 43% women, aged 35 to 64 years. We conducted 14 individual semi-structured interviews between 18/01/24 and 07/03/24 using Zoom’s video audio software, with an average duration of 65 min. We analyzed the data using Braun and Clarke’s method for reflexive thematic analysis, and generated themes by examining patterns of meaning throughout the dataset.ResultsData analysis generated three themes concerning the former surgical patients’ perspectives of patient safety culture and adverse events: (1) “Personalized care and predictable pathways increase patients’ sense of safety”; (2) “Surgical patients’ involvement: Aspire to be a resource – Not a threat”; and (3) “Time to cultivate a culture that fosters improvements and reconciliation.”ConclusionsThis study provided insight into patients’ perspectives on adverse events and patient safety culture in the surgical context. The patients underscored the value of predictable plans in caregiving, tailored information, personalized care, and dialogue on equal terms. They considered the demand for efficiency, professional hierarchy, status, prestige, and authority to be barriers to patient engagement and safety. Interventions to improve a culture of openness, psychological safety, and organizational learning in the surgical context could increase the safety of patients and healthcare professionals. Finally, acknowledgment of adverse events, information, and follow-up were essential for patients and next of kin to move on after an adverse event.

Teledermatology: Canadian dermatologists' practice patterns, perceived challenges and future recommendations.

The use of teledermatology has increased significantly in recent years. The objective of this study was to determine Canadian dermatologists' and dermatology residents' perspectives on teledermatology. An online survey was created to determine participants' teledermatology practice patterns and their perception of the challenges, education, training, and research in teledermatology. The survey was distributed through the Canadian Dermatology Association and by administrative staff at Canadian Dermatology departments. There were 33 respondents: 66.7% of respondents started using teledermatology during the COVID-19 pandemic, and 93.8% reported that teledermatology accounted for 0-25% of their practice. Convenience, access, and safety were identified as the primary advantages of teledermatology. Teledermatology was mainly utilized for medication monitoring or refills and to assess, manage, or follow up on dermatitis, other chronic inflammatory conditions, and pre-diagnosed dermatologic conditions. Poor photo quality (32.3%) and the inability to conduct physical examinations or accurately diagnose conditions (74.2%) were reported as significant challenges. Respondents recommended education on the medicolegal considerations of teledermatology and research on how teledermatology compares to in-person consultations. Overall, teledermatology offers convenience, access, and improved safety for patients and healthcare professionals. However, addressing challenges related to physical examinations, accurate diagnoses, and photo quality is essential for optimal care delivery.

Evaluating the Contribution of Healthcare Administrators in Promoting Occupational Safety

The role manager’s play in fostering safety at work has attracted much attention as healthcare environments increasingly more complex. Though they front lines in providing vital services, healthcare professionals also run several hazards in their jobs. The need of healthcare managers in supporting a mentality of safety in healthcare institutions is examined in this article. It looks at how managers may change safety rules, provide training courses, use safety safeguards, and guarantee legal observance to lower dangers at their place of work. The research underlines how important it is for leaders to establish safety targets, monitor staff members’ health and safety, and guarantee that medical professionals have the right tools and expertise to sustain their as least possible safety. The study also covers how laws, organisational structure, and budget allocation might contribute to improve safety results. Several research and case studies are investigated in this study in order to pinpoint the most important steps healthcare managers should follow in managing problems including mental health, stress, accident prevention, and infections. It also underlines the necessity of ongoing evaluation and change of safety rules to fit changing problems in the medical field. This article investigates how crucial managers are for reducing workplace hazards and ensuring everyone is safe by means of their decisions impacting safety outcomes. Ultimately, it emphasises that effective healthcare administration entails prioritising the health and safety of healthcare professionals above mere seamless execution of activities.

Healthcare Management Approaches for Improving Employee Occupational Safety

Introduction: in healthcare environments, occupational safety is rather crucial to guarantee that patients and staff get the best treatment available. Healthcare professionals run many hazards, including injury, disease, and extreme emotional stress; all of which may significantly affect their performance and general state of health. Thus, one crucial component of healthcare administration is ensuring employees’ safety at work.Method: this paper investigates many approaches to provide occupational safety for medical professionals. Every present safety regulation, training initiative, and technological solution was thoroughly examined. Data was obtained from many medical institutions using these approaches. Among the tools used were surveys, talks with staff members and healthcare management, and analysis of safety incident data.Results: safety management systems, consistent safety training, the use of personal protective equipment (PPE), and mental health support programs have helped to reduce the incidence of accidents, infections, and stress-related issues occurring at work, the research showed. Additionally demonstrated to reduce physical stress is the use of technology and robotics, therefore enhancing the safety and efficiency of many fields.Conclusion: the findings reveal that a multifarious approach is required to make healthcare professionals safer. This includes utilising mental health assistance, training, and technology. To safeguard the health and safety of their staff, healthcare providers should rank these actions first among their objectives. This will raise patient receiving quality of treatment. Future studies should investigate the long-term consequences of these developments as well as other technological innovations potentially used in safety management.

The occupational hazards of anesthesiologists: A literature review and evidence-based approach to prevention

Background An occupational hazard is any workplace condition that poses a risk to an employee's health. Occupational hazards are ubiquitous in the field of anesthesiology and often go underappreciated. These hazards warrant careful assessment and strategic preventative planning. Objective This narrative literature review examines the occupational hazards encountered by anesthesiologists and discusses evidence-based techniques to mitigate these risks. Facilitating the health and safety of anesthesia professionals protects not only the providers themselves but also enhances patient care by reducing the possibility of medical errors due to occupational fatigue, stress, and injuries. Methods A targeted search of PubMed and other databases (SCOPUS, Web of Science) was used to review the literature. Safety standard handbooks by the International Atomic Energy Agency, The Pan American Health Organization, The World Health Organization, and Food and Agriculture of the United Nations, were also consulted to provide the current guidelines for hazards discussed. Articles and information were included if they provided information about the occupational hazards of anesthesiologists or evidence-based prevention techniques for mitigating the hazards. Results The occupational hazards are classified into physical, chemical, and biological categories. Evidence-based preventive measures are proposed and examined for each category. Conclusion This paper examines the challenges faced by anesthesiologists by categorizing the physical, chemical, and biological occupational hazards. Each identified hazard is accompanied by evidence-based strategies to mitigate its impact. By illuminating these issues, increased awareness among healthcare professionals, policymakers, and the public can foster a collective effort to improve the safety of the work of anesthesia providers.

Axe and a Handshake – A Scoping Review of the Transition from Public Safety Occupations

Exiting a public safety occupation (e.g., paramedics, police, firefighters) and entering retirement is unique in many ways. There are heightened risks and demands associated with essential emergency services that involve personal sacrifices and commitment and the absence of this intense role is significant requiring an adjustment. Public safety personnel (PSP) leave their professions for various reasons including age-related retirement and forced retirement due to illness or injury and little is known about their experiences during the transition. The objective of this review is to summarize the existing body of research. The methodology for scoping reviews outlined in the five-stage framework by Arksey and O’Malley (2005) was followed. Abstract screening of 5,801 papers yielded 128 studies for full-text screening. Forty-five papers were accepted by at least two of three reviewers for data extraction and analysis. High level themes emerged including cumulative impacts, separation from identity and culture, and buffers. The study found that there is a need for planning and support for those exiting public safety professions. Financial planning is the focus of pre-planning when it exists and applied research is needed to further understand psychosocial risk and protective factors to support the development of acceptable transition strategies and resources.

Personal safety of female medical professionals in hospitals: A call to action

Personal safety of female medical professionals in hospitals: A call to action

Well–being as a Predictor of Turnover Intention: A Quantitative Study of Occupational Safety and Health Professionals in the U.S.

This quantitative correlational regression study examines the relationship between employee well–being and turnover intention among occupational safety and health (OSH) professionals in the United States. Previous research highlights a decline in well–being and an increase in turnover intention among OSH professionals. This study focuses on how well–being predicts turnover intention, utilizing simple linear regression analysis on data from two surveys. Results show a weak to moderate predictive relationship between affective well–being and turnover intention. The sample consists of U.S. OSH professionals, predominantly from the Western region. The findings align with self–determination theory (SDT), suggesting that satisfying basic psychological needs—autonomy, competence, and relatedness—enhances well–being, influencing turnover intention. When individuals experience positive emotional states and their emotional needs are met, they exhibit higher well–being and job satisfaction. This study contributes to understanding the well–being–turnover intention dynamic in the OSH field, offering insights into organizational retention strategies and employee support programs.

Factors Influencing the Adoption of Antibody-Drug Conjugates in Oncology: A Statistical Study

Hepatitis Antibody-Drug Conjugates (ADCs) represent a promising targeted therapy combining monoclonal antibodies with chemotherapy agents, offering enhanced therapeutic efficacy and reduced toxicity to normal cells, particularly in oncology. Despite this potential, widespread adoption remains constrained by key challenges. This study investigates the utilization of ADCs in oncology, focusing on clinical outcomes, safety, costs, regulatory hurdles, and healthcare professionals' awareness. A survey of 200 healthcare professionals, including oncologists, pharmacists, and administrators, was conducted to assess expectations and experiences with ADCs across clinical value, cost, and compliance dimensions. Data analysis was performed using SPSS, employing descriptive statistics, ANOVA, Chi-Square tests, and logistic regression. Results revealed clinical effectiveness and safety as primary factors influencing ADC adoption. However, significant barriers included costs (47%) and regulatory issues (52%), limiting broader application. A Chi-Square analysis indicated a significant correlation between the frequency of ADC recommendation and healthcare professionals' exposure to ADC-related concepts, underscoring the importance of familiarity in promoting ADC use. ANOVA demonstrated cost concerns were more pronounced in private hospitals compared to public institutions. Logistic regression highlighted clinical effectiveness and technological advancements as the strongest predictors of ADC adoption. The findings suggest prioritizing cost-reduction strategies, streamlining regulatory processes, and enhancing awareness through education campaigns to increase ADC utilization. Future strategies should emphasize competitive pricing, improved regulatory clarity, and expedited approval processes to facilitate broader access to these life-saving therapies in oncology.

Artificial Intelligence in Pharmacovigilance

Abstract: Pharmacovigilance (PV) is a data-driven method that quickly identifies medication safety risks by processing reports of suspected Adverse Events (AEs) and extracting health data. The first steps in the PV case processing cycle include data collection, data entry, coding, preliminary validity and completeness checks, and medical evaluation for severity, seriousness, expectation, and causality. Afterward, a report is submitted, quality is checked, and data storage and maintenance are performed. This process is costly and time-consuming, as it requires both a workforce and technology. Conversely, Artificial Intelligence (AI) is used to reduce this time investment and increase data accuracy. AI includes machine learning methods like deep learning and natural language processing, which can recognize and retrieve information on adverse drug occurrences. By doing so, it is possible to optimize the pharmacovigilance process and improve the tracking of documented adverse medication occurrences. AI's advancement in pharmacovigilance raises concerns about potential changes in drug safety professionals' roles, prompting curiosity about their future in an AI-assisted workplace. Artificial Intelligence (AI) should augment human intelligence, not replace human specialists. It's crucial to highlight and ensure AI improves PV more than it causes problems. The pharmaceutical business faces significant obstacles and opportunities, especially when it comes to implementing and employing advanced Information Technology (IT) in Pharmaceutical Monitoring (PMS) Systems. Automation improves PV in several ways (e.g., boosting data quality or improving consistency). Several themes are discussed, outlining the challenges encountered, exploring potential solutions, and emphasizing the need for further research. The accepted use case involves automating the workflow in the case of ICRS.

Effect of Dairy Farm Supervisor Leadership Training on Workplace Safety Climate

Background: Assessment of workplace safety climate is a recognized approach to assess safe culture in an organization. We developed, implemented, and evaluated a 12-module safety leadership and management e-learning training program tailored for front-line dairy farm supervisors and hypothesized that such a training program would have a positive effect on occupational safety climate. Methods: We enrolled 103 dairy farm supervisors from 35 U.S. farms to participate in a 12-module dairy leadership training program. We assessed safety climate change among supervisors and their workers using a pre-post training intervention methodology. A 24-item, 8-factor safety climate survey was developed and completed pre- and post-training by 65 supervisors and 313 (pre) and 238 (post) workers under their supervision. Findings: Significant improvements were seen on the 14-item supervisor safety climate scale, the 10-item group safety climate scale, and subscales regarding safety priority, empowerment, and dealing with conflicts. No significant improvements were seen for the factor regarding leaders encouraging workers to report safety incidents, as these were already rated highly. Conclusions: Findings suggest safety leadership e-learning training among dairy farm supervisors can result in positive safety climate change among supervisors and subordinate workers. Application to Practice: This study provides a framework for researchers, safety professionals, and training developers for the successful implementation of a safety leadership training program, and its effect on safety climate. Additional research is needed on the effectiveness and sustainability of safety leadership training in high-risk industrial sectors such as agriculture.

PPE shortages and healthcare workers' mental health during the COVID‐19 pandemic in Canada

AbstractPersonal protective equipment (PPE) is critical among healthcare professionals, considering that it serves as the first line of defense against infectious diseases and hazards in the healthcare environment. Therefore, the shortage of PPE during the COVID‐19 pandemic exposed a unique vulnerability within the healthcare system, heightening the risk of infection among healthcare professionals. Despite this evidence, few studies have explored whether this negative impact of PPE scarcity extends to mental health among healthcare professionals in Canada. Using the Survey on Healthcare Workers' Experiences During the Pandemic conducted by Statistics Canada (n = 12,246), the current study aims to address this void by exploring the association between PPE shortages and two indicators of mental health—depression and general anxiety disorder. We found that 18% and 26% of healthcare professionals reported depression and general anxiety disorder, respectively. Results from logistic regression analyses indicate that healthcare professionals who faced at least one PPE restriction were more likely to report general anxiety disorder. Additionally, professionals who experienced four or more restrictions were more likely to report depression (OR = 1.28, p<0.01), compared to those who did not experience any restriction. Based on these findings, we discuss whether the stress and anxiety resulting from inadequate protection during the pandemic may point to the importance of understanding the broader implications of PPE shortages on the mental well‐being of healthcare professionals. The current study highlighted that it is essential to craft evidence‐based policies that not only prioritize the physical safety of healthcare professionals but also their mental well‐being, ultimately strengthening the healthcare system's response to crises.

THE ROLE OF KNOWLEDGE IN PREVENTING MALARIA INCIDENCE AMONG PADDY FARMERS IN NORTHERN MALAYSIA

The agriculture sector is notoriously associated with hazardous activities and high occupational accident rates, with most studies focusing on physical and chemical hazards. Biological hazards including zoonoses have been less studied due to scarce information and diverse perplexing factors that hinder the development of risk assessment activities by safety professionals. Zoonotic malaria, a communicable disease, has recorded upsurge in the infection rates in Malaysia. Malaria, a mosquito-borne infectious disease, poses significant risks to individuals working in agricultural settings, particular paddy farmers. Paddy farmers are highly vulnerable to these diseases due to their exposure to working environments such as stagnant water in the paddy field. This study aims to explores the relationship between the role of knowledge about malaria in preventing the incidence of malaria, highlighting the specific occupational challenges encounter by paddy farmers in Northern region of Malaysia. We propose the hypothesis that enhanced knowledge and awareness among paddy farmers about malaria and its prevention can contribute to notable reduction in the incidence of malaria. To test this hypothesis, we will conduct a questionnaire survey which will be distributed to collect data from selected paddy farming communities. The survey will evaluate the current level of knowledges associated with malaria prevention. The result of this study will provide valuable insight into the role of education and knowledge dissemination in alleviating biological hazards, with a main focus on malaria among the paddy farmers. Moreover, this research could contribute to the refinement of policy and practical interventions focusing in improving occupational health and safety of agricultural communities, ultimately boosting health outcomes and declining occupational accident rates.

Leadership support for Clery Act compliance doesn’t necessarily translate into resources

While the majority of campus safety professionals believe they have the support of their administration for Clery Act‐related safety policies, that support doesn’t always translate into the necessary financial investment, according to a new study. In fact, only 42.6% of respondents agreed that their department had an appropriate amount of financial resources devoted to Clery Act compliance.

Approaching Human Error in Industrial Settings: Memento for Romanian Occupational Health and Safety Professionals

Abstract In recent decades, in addition to numerous work accidents in which tens of thousands of deaths, disabilities and millions of days of temporary inability to work have been recorded, we have unfortunately witnessed some major disasters and accidents due to human errors. Indeed, one of the main identified contributors to the occurrence of these undesirable events stems from latent/active human errors. In this article, we try to develop a selective synthesis of some approaches to human error, different characteristic types, models and methodologies that have been developed to support the minimization of these errors. Relevant aspects of human error are systematized, including applicable systems for effective risk management in order to provide Romanian OSH specialists with tools for deepening/understanding a decisive and - at the same time - insufficiently studied aspect at the national level.

Developing a culturally-responsive training program: Workplace violence against physicians in Türkiye

Workplace violence against physicians is a critical issue in Türkiye, requiring comprehensive strategies for prevention and management. This paper outlines the development of a culturally-responsive training program aimed at equipping Turkish physicians with the skills and knowledge needed to effectively address workplace violence. The program is built on the findings from semi-structured interviews with Turkish physicians, a national survey of 136 healthcare workers, historical analysis of workplace violence against physicians in Turkish online newspaper archives, and a workshop with practicing physicians, medical professors, communication experts, and patients. The training program integrates cultural sensitivity and empirical evidence to create a robust framework for mitigating violence in healthcare settings. The training consists of 16 interactive units, each focusing on different aspects of workplace violence and its management specific to Turkish hospital settings. They incorporate real-life scenarios, practical suggestions, and legislative guidelines on effectively managing and mitigating violence. By simulating actual situations, the modules provide hands-on experience and practical knowledge. A crucial aspect of the training is its culturally-responsive approach, which addresses the unique cultural dynamics and sensitivities within Turkish healthcare environments. This program ensures that Turkish physicians can perform their duties without fear of violence while respecting and understanding the cultural values and dynamics of Turkish society. This culturally-responsive dimension is key to creating an effective and impactful training program that enhances the safety and well-being of healthcare professionals in Türkiye.

Assessment of injection safety practices among anesthesiologists in tertiary care hospitals in Karachi

Background: Injections play a critical role in the medical management of patients, particularly those with severe health conditions, across hospitals and healthcare institutions. However, ensuring adherence to proper injection safety protocols is essential to prevent avoidable medical errors and infections. The objective of this study was to evaluate the compliance with injection safety protocols among anesthesiologists working in tertiary care institutions in Karachi. Methodology: A cross-sectional study was conducted in tertiary care hospitals in Karachi between November 2021 and April 2022, with a study duration of six months. A total of 200 anesthesiologists participated in the study. Data were collected through a pre-designed questionnaire, which was completed by the participants. All responses were kept confidential to ensure anonymity. The study aimed to assess adherence to injection safety protocols among anesthesiologists working in these institutions. Results: Among the 200 anesthesiologists surveyed, 18.5% were found to engage in malpractice regarding injection safety practices, while the remaining 81.5% adhered to acceptable injection safety protocols. Statistical analyses were performed to explore the relationship between age, years of experience, and other demographic factors, revealing no significant differences between those following acceptable practices and those engaging in malpractice. Conclusion: The study concludes that enhancing awareness and providing training on injection safety for healthcare professionals can significantly improve compliance and reduce the incidence of needle-stick injuries. It is recommended that regular training sessions and updated safety protocols be implemented in all healthcare facilities to further minimize the risks associated with unsafe injection practices.

Measuring improvements in occupational health and safety in the artificial stone benchtop industry.

Workers in the stone benchtop industry in Australia are at high risk of silicosis due to exposure to respirable crystalline silica (RCS) from the dry processing of artificial stone. In Victoria, Australia, a multifaceted response including education, regulatory changes, inspection site visits, and occupational health screening programme began in 2019. We aimed to review the success of this approach to safety practices in the industry. Data were available from 2 sources: first, responses provided by workers during their occupational health screening (2019 to 2024), which included a systematic occupational history. Jobs examined included roles in the stone benchtop industry with RCS exposure and were analysed in relation to reported safety practices pre and postregulatory changes in August 2019, which prohibited unrestricted dry cutting. Second, data were obtained from the Regulator describing the numbers of visits to industry worksites and the numbers and types of compliance notices issued between 2018 and 2024. In total, 1921 jobs from 1007 workers were eligible for analysis, of which 869 were prior to the 2019 regulatory change and 557 commenced after. The proportion of workers reporting "never" dry cutting rose from 17.3% to 67.2% (P < 0.001), use of recommended ventilation and respirator increased from 26.0% to 36.5% (P < 0.001), and 44.9% to 86.5% (P < 0.001), respectively. Of the 543 worksites visited (2757 site visits in total), 352 (64.8%) received at least one compliance notice and the types of notices varied over time. Administrative controls/housekeeping and health monitoring notices were the most common in 2019 to 2021 but tools/equipment notices increased substantially in 2022 onwards. Prior to the changes, a large proportion of jobs involved unrestricted dry processing of artificial stone with inadequate protection. After the changes, practices improved although some jobs continued to involve dry processing without adequate control of dust. This multifaceted approach vastly improved safety practices in the stone benchtop industry over 5 years. These data are relevant to occupational health and safety professionals and regulators in countries where artificial stone is used and potentially for implementation of new measures in response to a new workplace hazard in future.

Science or Spectacle? A Critical Evaluation of the decade of Aesthetic Medicine Conferences using Punctuated Equilibrium Framework.

The global aesthetic medicine industry is rapidly expanding, with conferences serving as crucial platforms for knowledge exchange and collaboration. However, concerns have emerged about the increasing prioritisation of commercial content over scientifically rigorous presentations. This study critically evaluates the balance between commercial and scientific content at aesthetic medicine conferences, utilising artificial intelligence (AI) tools to analyse the impact of industry sponsorship and live procedural demonstrations on educational value. Using the Punctuated Equilibrium Framework (PEF), AI-driven content analysis, social network analysis (SNA), and sentiment analysis were applied to evaluate conference data, including programs, sponsorship details, speaker affiliations, and attendee engagement metrics. The study analysed global and regional aesthetic medicine conferences from 2014 to 2024, identifying patterns and punctuated shifts in the balance between scientific and commercially driven content. AI-based analysis of 487 conferences, comprising over 28,000 sessions and 2 million social media posts, revealed an increasing trend towards commercially focused content, particularly in industry-sponsored events. Approximately 44% of sessions were commercially oriented, with significant spikes during product launches. Academic and clinical speakers were more prevalent in scientific conferences, while industry-affiliated speakers dominated commercial sessions. Social media sentiment, analysed using AI tools, reflected high engagement with procedural demonstrations but also highlighted concerns about educational quality. While industry-driven sessions garnered higher immediate engagement, they reduced long-term cognitive retention and compromised the educational integrity of conferences. The use of AI in this study enabled a deeper understanding of content trends and their effects. Aesthetic medicine conferences must recalibrate the balance between commercial interests and scientific rigour to ensure sustainable professional development and patient safety. IV.

Assessing the safety of international examples of bicycle streets to identify important design elements—an expert judgement

The two most common types of cycling infrastructure are separated bicycle tracks and bicycle lanes. Several studies have been carried out to examine their impact on cycling safety. A relatively new type of cycling infrastructure, which is increasingly being implemented, is the bicycle street, defined as a street where bicycle traffic is prioritised and where motorised vehicles are limited in terms of volume and speed. Since bicycle streets are developed recently, the literature about their safety is scarce. Therefore, in order to provide directions for further research to the safety of bicycle streets, the present study aims to identify which design elements of bicycle streets are important to assess their safety, based on expert judgement. The expert judgement data were collected from 49 cycling safety professionals, divided over ten groups, during a workshop about the safety of bicycle streets during the 11th International Cycling Safety Conference 2023 in the Hague. The groups of cycling safety professionals categorised nine international examples of bicycle streets over three piles: ‘Safest’, ‘In between’, and ‘Least safe’. They also provided arguments about why they put a bicycle street on a specific pile. These arguments are used to identify important design elements that impact the safety of bicycle streets and are compared to existing literature. The results showed that expert judgements are considerably similar across the example bicycle streets and their design elements. The most important design elements to assess the safety are: width of the street, design to prioritise cyclists, road markings and parking. The literature shows that for some elements, general road safety knowledge exists, but that for most design elements no studies exist that examine their relation to the safety of bicycle streets in particular.