First, Do Less Harm: Confronting the Inconvenient Problems of Patient Safety

[Excerpt] This book is an exploration of why patient safety is advancing at what seems to be an almost glacial pace, despite the often vast and determined efforts of health care workers and managers. A collection of essays from prominent researchers, scholars, and even patients, this book aims to identify some of the gaps in the patient safety movement, the disconnected dots that do not coalesce despite decades of hard work and billions of dollars. It also identifies concerns that have not been integrated into the patient safety discourse or agenda of more established groups

Collaborative Caring: Stories and Reflections on Teamwork in Health Care

[Excerpt] There are many theoretical and conceptual books and countless articles that have explored issues of teamwork in general and teamwork in health care in particular. The editors, and many of the authors in this book, have read most, and have even written some of them. To tackle the issue of teamwork, we have, however, taken a different approach. Rather than write a theoretical book about what teamwork is, what it is not, where it exists in health care, what barriers prevent its implementation and how they can be removed, we have chosen instead to address these questions through narratives and reflections that vividly describe good teamwork as well as problems in creating, leading, and working on genuine teams. What we believe is too often lacking in the literature is a clear and compelling picture of what teamwork looks like on the ground, in the institutions where health care work is delivered and where teams play well, or don\u27t play well, on a daily basis. The question we ask here is thus: What is the state of play in most health care institutions? To describe the state of play, we have asked clinicians to write what we think of as where the rubber hits the road stories or reflections about the nature of teamwork in their own particular work setting. To gather these stories, we talked to many people in different health care disciplines. In the invitation for submissions we wrote the following: We are seeking short, concise narratives that describe a concrete example in which you personally have been involved. The idea here is not to focus so much on the individual doctor-patient, nurse-patient, therapist-patient communication but the teamwork that was involved in ensuring that the standard of care was met or exceeded. If the patient or family was involved, so much the better. Stories can deal with interprofessional or intraprofessional teamwork. On balance, we would prefer to have more stories about interprofessional or occupational teamwork. Nonetheless, we recognize that interprofessional work depends on the ability to create teamwork within an occupation or profession. Stories involving support staff, such as housekeepers who spoke up about a patient safety issue, are definitely within the purview of this book. We would also welcome personal reflections that would enhance our understanding of either how to produce genuine teamwork or the obstacles that stand in its way

AIDS patients have increased surfactant protein D but normal mannose binding lectin levels in lung fluid.

BACKGROUND: Surfactant protein D (SP-D) and Mannose Binding Lectin (MBL) are collectins that have opsonic and immunoregulatory functions, are found in lung fluid and interact with the human immunodeficiency virus (HIV). We compared collectin levels in lung fluid and serum from HIV infected and normal subjects to determine if alterations in lung collectin levels were associated with HIV infection and might result in increased susceptibility to other pulmonary infections. METHODS: Blood and bronchoalveolar lavage samples were collected from 19 HIV-infected individuals and 17 HIV-uninfected individuals, all with normal chest X ray at time of study. HIV viral loads and peripheral blood CD4+ T cell counts were measured in all subjects. SP-D was measured in lung fluid, and MBL in both lung fluid and serum. RESULTS: SP-D levels were not significantly different in lung fluid from HIV-uninfected (median 406.72 ng/ml) and HIV-infected individuals with high CD4 count (CD4 >200) (median 382.60 ng/ml) but were elevated in HIV-infected individuals with low CD4 count (median 577.79 ng/ml; Kruskall Wallis p < 0.05). MBL levels in serum were not significantly different between HIV-uninfected and HIV-infected individuals (median 1782.70 ng/ml vs 2639.73 ng/ml) and were not detectable in lung fluid. CONCLUSION: SP-D levels are increased in lung fluid from AIDS patients but not in patients with early HIV infection. MBL levels are not altered by HIV infection or AIDS. There is no evidence that altered pulmonary collectin levels result in susceptibility to infection in these patients

PATENTS-EXCLUSIVE LICENSES-LICENSOR AND LICENSEE RELATIONSHIP- LLICENSEE\u27S OBLIGATIONS

Patent licensing is today, as always, a very significant part of patent law. Since royalty licenses allow a patentee to realize pecuniary benefits from his invention without yielding ownership, as he would by an assignment, they are especially attractive to an inventor who anticipates considerable commercial success for his contribution, and who does not desire to lose all control of the invention for a lump sum, the adequacy of which must be, at best, speculative. From the licensee\u27s standpoint, it is usually advantageous to be free of competition from others also operating under the same patent monopoly, at least within a limited area, and consequently an exclusive license is to his advantage. There is no question but that an exclusive license presents various advantages to both parties, and the proportion of patent licenses which are of an exclusive nature is therefore considerable. A peculiar relationship, however, arises between patentees and their exclusive licensees, which does not arise in the case of an ordinary nonexclusive license, and which entails certain implied obligations on the part of the exclusive licensee. The patent licensee\u27s obligations, while established in other fields of contract-license law, have recently been questioned, and will undoubtedly be the storm center of conflicting policies for some time to come. The subject is therefore considered to be of interest, and it is the purpose of this comment to summarize the position of the courts on the matter as it has been expressed up to the present time

CONTRACTS-RIGHTS OF THIRD PARTY BENEFICIARY-EFFECT OF MICHIGAN BENEFICIARY CONTRACT STATUTE

On agreement to make mutual wills, Stephen and his two sisters entered into an agreement whereby the sisters agreed to will to Stephen, or in event Stephen predeceased them, to his wife, all property which they should receive from their father. Stephen did predecease the sisters, whereupon they executed new wills with no provision for Stephen\u27s widow. Upon death of the last sister, the widow\u27s bill for specific performance of the agreement was dismissed by the circuit court. In affirming on appeal, the Michigan Supreme Court held that the agreement as to Stephen and all other persons except the sisters being without consideration, the sisters were each bound only at the option of the other while both lived, and each could revoke with the other\u27s permission. Execution of the new wills showed a common purpose to do away with all agreements to leave plaintiff anything, the will of each sister amounting to a revocation of the agreement, to which the consent of the other sister is fairly to be inferred in the absence in the contract of any stipulation requiring revocation to be in writing. Rose v. Southern Michigan National Bank of Coldwater, 328 Mich. 639, 44 N.W. (2d) 192 (1950)

Family-witnessed resuscitation in emergency departments: Doctors’ attitudes and practices

Background. Resuscitation of patients occurs daily in emergency departments. Traditional practice entails family members remaining outside the resuscitation room. Objective. We explored the introduction of family-witnessed resuscitation (FWR) as it has been shown to allow closure for the family when resuscitation is unsuccessful and helps them to better understand the last moments of life. Results. Attending medical doctors have concerns about this practice, such as traumatisation of family members, increased pressure on the medical team, interference by the family, and potential medico-legal consequences. There was not complete acceptance of the practice of FWR among the sample group. Conclusion. Short-course training such as postgraduate advanced life support and other continued professional development activities should have a positive effect on this practice. The more experienced doctors are and the longer they work in emergency medicine, the more comfortable they appear to be with the concept of FWR and therefore the more likely they are to allow it. Further study and course attendance by doctors has a positive influence on the practice of FWR

On the Photometric Accuracy of RHESSI Imaging and Spectrosocopy

We compare the photometric accuracy of spectra and images in flares observed with the Ramaty High Energy Solar Spectroscopic Imager (RHESSI)}spacecraft. We test the accuracy of the photometry by comparing the photon fluxes obtained in different energy ranges from the spectral-fitting software SPEX with those fluxes contained in the images reconstructed with the Clean, MEM, MEM-Vis, Pixon, and Forward-fit algorithms. We quantify also the background fluxes, the fidelity of source geometries, and spatial spectra reconstructed with the five image reconstruction algorithms. We investigate the effects of grid selection, pixel size, field-of-view, and time intervals on the quality of image reconstruction. The detailed parameters and statistics are provided in an accompanying CD-ROM and web page. We find that Forward-fit, Pixon, and Clean have a robust convergence behavior and a photometric accuracy in the order of a few percents, while MEM does not converge optimally for large degrees of freedom (for large field-of-views and/or small pixel sizes), and MEM-Vis suffers in the case of time-variable sources. This comparative study documents the current status of the RHESSI spectral and imaging software, one year after launch.Comment: 2 Figures, full version on http://www.lmsal.com/~aschwand/eprints/2003_photo/index.htm