Software fault-tolerance by design diversity DEDIX: A tool for experiments

The use of multiple versions of a computer program, independently designed from a common specification, to reduce the effects of an error is discussed. If these versions are designed by independent programming teams, it is expected that a fault in one version will not have the same behavior as any fault in the other versions. Since the errors in the output of the versions are different and uncorrelated, it is possible to run the versions concurrently, cross-check their results at prespecified points, and mask errors. A DEsign DIversity eXperiments (DEDIX) testbed was implemented to study the influence of common mode errors which can result in a failure of the entire system. The layered design of DEDIX and its decision algorithm are described

The UCLA Design Diversity Experiment (DEDIX) system: A distributed testbed for multiple-version software

To establish a long-term research facility for experimental investigations of design diversity as a means of achieving fault-tolerant systems, a distributed testbed for multiple-version software was designed. It is part of a local network, which utilizes the Locus distributed operating system to operate a set of 20 VAX 11/750 computers. It is used in experiments to measure the efficacy of design diversity and to investigate reliability increases under large-scale, controlled experimental conditions

Knowledge of pressure ulcer prevention: a cross-sectional and comparative study among nurses

BACKGROUND: Pressure ulcers are a common, painful and costly condition. Results of a 1991 study into the knowledge among Dutch hospital nurses on the usefulness of measures to prevent pressure ulcers showed moderate knowledge. Results were confirmed by subsequent studies. In recent years, Dutch guidelines have been updated and the attention given to pressure ulcer care has been increased. This was expected to improve pressure ulcer care and to increase nurses' knowledge. The aims of the current study were to investigate (1) how much nurses employed in Dutch hospitals know about the usefulness of 28 preventive measures considered in the most recent national pressure ulcer guideline; (2) whether differences in knowledge exist between nurses working in hospitals that audit pressure ulcers and those employed in hospitals that do not; and (3) to study whether knowledge among Dutch hospital nurses regarding the usefulness of preventive measures had changed between 1991 and 2003. METHODS: A cross-sectional study design among nurses employed in Dutch hospitals in 2003 was used to investigate their knowledge and differences in knowledge between nurses employed in different types of institution. A comparative design was used to assess whether knowledge differed between this population and that of Dutch hospital nurses in 1991. The nurses' knowledge was assessed by a written questionnaire. Data of 522 respondents meeting the inclusion criteria were analyzed and compared with the results of the 351 nurses included in the 1991 study. RESULTS: Knowledge in 2003 was slightly better than that in 1991. The nurses were moderately aware of the usefulness of preventive measures. Nurses employed in organizations that monitored pressure ulcers did not display greater knowledge than those employed in organizations that did not do so. CONCLUSION: Knowledge among Dutch hospital nurses about the usefulness of measures to prevent pressure ulcers seems to be moderate. Being employed in an institution that monitors pressure ulcer care hardly affects the knowledge level. Knowledge about prevention has improved little since 1991

Improving assessment of postoperative pain in surgical wards by education and training



Problem: There is a need to improve postoperative pain organisation and management in hospitals. One of the most important factors in achieving this is to improve active assessment of pain in the postoperative phase. Design: Repeated audits on an annual basis over a 3 year period. Ward nurses, appointed as "pain control representatives", performed the data collection. Setting: Departments of general surgery and orthopaedics in a university hospital with 1200 beds. Key measure for improvement: Assessment of postoperative pain intensity using a numerical rating scale. Strategies for change: On the basis of the first audit in 1999 the team decided to introduce a mandatory training programme in postoperative pain management for all involved staff, including surgeons and ward nurses. Guidelines for postoperative care were upgraded and made accessible through the intranet. Regular staff meetings in the surgical wards with representatives from the acute pain service team were introduced. Effects of change: The assessment of pain according to protocols increased from 71% to 91% in the surgical wards and from 60% to 88% in the orthopaedic wards between 1999 and 2001/2. Lessons learnt: To increase the awareness of pain and improve pain assessment, the importance of mandatory training, regular staff meetings and regular audits must be emphasised. It is also imperative to give feedback on the regular audits to the ward and staff members involved

Quality of Life and Social Life Situation in Islet Transplanted Patients: Time for a Change in Outcome Measures?

Background: One of the overall goals in health care is to prolong life, increase patients’ wellbeing and quality of life. Many of patients with severe insulin-dependent diabetes mellitus experience fear of hypoglycemia (FoH), which forces them to change their lives both physically and socially to avoid episodes of hypoglycemia.Objective: To investigate the quality of life and the social life situation, with special focus on the consequences of FoH in islet transplanted patients.Methods: 11 patients (4 women and 7 men) were included; they have undergone islet transplantation at Uppsala University Hospital during the period 2001–2009. Short Form 36 (SF-36) and the Swedish version Hypoglycemia Fear Survey (Swe-HFS) were used to investigate quality of life, in relation to FoH. In addition, telephone interviews were conducted to investigate the patients social life situation in relation to FoH, after islet transplantation and were analyzed using a content analysis method.Results: The mean value for quality of life was lower than that in the normal population. 3 out of 10 patients experienced FoH; one patient declined to answer the questionnaire. 3 predominant themes were revealed; one theme associated with pre-transplant, was “struggle for control of social life situation” and two themes associated with post-transplant, were “regain power and control of social life situation” and “at peace with the balance between the present and the future.”Conclusion: The patients experienced improved control over social life situation while quality of life in relation to FoH may have improved following islet transplantation

To receive or not to receive analgesics in the emergency department: the importance of the pain intensity assessment and initial nursing assessment

Abstract not availableÅsa Muntlin Athlin, Marianne Carlsson, Lena Gunningber