Enhancing patient safety by integrating ethical dimensions to Critical Incident Reporting Systems

Background Critical Incident Reporting Systems (CIRS) provide a well-proven method to identify clinical risks in hospitals. All professions can report critical incidents anonymously, low-threshold, and without sanctions. Reported cases are processed to preventive measures that improve patient and staff safety. Clinical ethics consultations offer support for ethical conflicts but are dependent on the interaction with staff and management to be effective. The aim of this study was to investigate the rationale of integrating an ethical focus into CIRS. Methods A six-step approach combined the analysis of CIRS databases, potential cases, literature on clinical and organizational ethics, cases from ethics consultations, and experts' experience to construct a framework for CIRS cases with ethical relevance and map the categories with principles of biomedical ethics. Results Four main categories of critical incidents with ethical relevance were derived: (1) patient-related communication; (2) consent, autonomy, and patient interest; (3) conflicting economic and medical interests; (4) staff communication and corporate culture. Each category was refined with different subcategories and mapped with case examples and exemplary related ethical principles to demonstrate ethical relevance. Conclusion The developed framework for CIRS cases with its ethical dimensions demonstrates the relevance of integrating ethics into the concept of risk-, quality-, and organizational management. It may also support clinical ethics consultations' presence and effectiveness. The proposed enhancement could contribute to hospitals' ethical infrastructure and may increase ethical behavior, patient safety, and employee satisfaction

Gesundheitslabel: Eine Bestandsaufnahme

Die Gesundheit von Mitarbeitenden am Arbeitsplatz ist ein Thema, das vor dem Hintergrund des demografischen Wandels und der zunehmenden Forderung nach sozialer Verantwortung in ökonomischen Kontexten in vielen Industrienationen zusehends an Relevanz gewinnt. Ein klares Bekenntnis für die Mitarbeitendengesundheit stellen proaktive Programme der betrieblichen Gesundheitsförderung und des Gesundheitsmanagements dar. Für externe Unternehmen, Institutionen und ganz besonders für Endverbraucher bleiben diese Programme in der Regel allerdings intransparent. Verbraucher können die proaktive Fürsorge der Unternehmen nicht durch ihr Konsumverhalten honorieren, betrieblichen Partnern ist es nur vereinzelt möglich, kooperative Programme zu etablieren und hier Synergien zu nutzen und staatlichen Institutionen fällt es schwer, Regulierungen sinnvoll anzupassen. Vor diesem Hintergrund wurden viele in Deutschland gängige Label daraufhin überprüft, welche Einschätzung sie über die Gesundheitsförderung und das Gesundheitsmanagement des zertifizierten Unternehmens erlauben. Die Arbeit endet mit einer Evaluation der vielversprechendsten Label und einer politischen Empfehlung

Predictors of asthma control differ from predictors of asthma attacks in children: The Swiss Paediatric Airway Cohort.

BACKGROUND It is unclear if predictors of asthma attacks are the same as those of asthma symptom control in children. OBJECTIVE We evaluated predictors for these two outcomes in a clinical cohort study. METHODS The Swiss Paediatric Airway Cohort (SPAC) is a multicentre prospective clinical cohort of children referred to paediatric pulmonologists. This analysis included 516 children (5-16 years old) diagnosed with asthma. At baseline, we collected sociodemographic information, symptoms, personal and family history and environmental exposures from a parental baseline questionnaire, and treatment and test results from hospital records. Outcomes were assessed 1 year later by parental questionnaire: asthma control in the last 4 weeks as defined by GINA guidelines, and asthma attacks defined as any unscheduled visit for asthma in the past year. We used logistic regression to identify and compare predictors for suboptimal asthma control and asthma attacks. RESULTS At follow-up, 114/516 children (22%), reported suboptimal asthma control, and 114 (22%) an incident asthma attack. Only 37 (7%) reported both. Suboptimal asthma control was associated with poor symptom control at baseline (e.g. ≥1 night wheeze/week OR: 3.2; 95% CI: 1.7-6), wheeze triggered by allergens (2.2; 1.4-3.3), colds (2.3; 1.4-3.6) and exercise (3.2; 2-5), a more intense treatment at baseline (2.4; 1.3-4.4 for Step 3 vs. 1), history of preschool (2.6; 1.5-4.4) and persistent wheeze (2; 1.4-3.2), and exposure to tobacco smoke (1.7; 1-2.6). Incident asthma attacks were associated with previous episodes of severe wheeze (2; 1.2-3.3) and asthma attacks (2.8; 1.6-5 for emergency care visits), younger age (0.8; 0.8-0.9 per 1 year) and non-Swiss origin (0.3; 0.2-0.5 for Swiss origin). Lung function, exhaled nitric oxide (FeNO) and allergic sensitization at baseline were not associated with control or attacks. CONCLUSION Children at risk of long-term suboptimal asthma control differ from those at risk of attacks. Prediction tools and preventive efforts should differentiate these two asthma outcomes

VISIONS:the VISTA Star Formation Atlas I. Survey overview

VISIONS is an ESO public survey of five nearby (d < 500 pc) star-forming molecular cloud complexes that are canonically associated with the constellations of Chamaeleon, Corona Australis, Lupus, Ophiuchus, and Orion. The survey was carried out with the Visible and Infrared Survey Telescope for Astronomy (VISTA), using the VISTA Infrared Camera (VIRCAM), and collected data in the near-infrared passbands J (1.25 μm), H (1.65 μm), and KS (2.15 μm). With a total on-sky exposure time of 49.4h VISIONS covers an area of 650 deg2, it is designed to build an infrared legacy archive with a structure and content similar to the Two Micron All Sky Survey (2MASS) for the screened star-forming regions. Taking place between April 2017 and March 2022, the observations yielded approximately 1.15 million images, which comprise 19 TB of raw data. The observations undertaken within the survey are grouped into three different subsurveys. First, the wide subsurvey comprises shallow, large-scale observations and it has revisited the star-forming complexes six times over the course of its execution. Second, the deep subsurvey of dedicated high-sensitivity observations has collected data on areas with the largest amounts of dust extinction. Third, the control subsurvey includes observations of areas of low-to-negligible dust extinction. Using this strategy, the VISIONS observation program offers multi-epoch position measurements, with the ability to access deeply embedded objects, and it provides a baseline for statistical comparisons and sample completeness – all at the same time. In particular, VISIONS is designed to measure the proper motions of point sources, with a precision of 1 mas yr−1 or better, when complemented with data from the VISTA Hemisphere Survey (VHS). In this way, VISIONS can provide proper motions of complete ensembles of embedded and low-mass objects, including sources inaccessible to the optical ESA Gaia mission. VISIONS will enable the community to address a variety of research topics from a more informed perspective, including the 3D distribution and motion of embedded stars and the nearby interstellar medium, the identification and characterization of young stellar objects, the formation and evolution of embedded stellar clusters and their initial mass function, as well as the characteristics of interstellar dust and the reddening law

VISIONS:the VISTA Star Formation Atlas I. Survey overview

VISIONS is an ESO public survey of five nearby (d < 500 pc) star-forming molecular cloud complexes that are canonically associated with the constellations of Chamaeleon, Corona Australis, Lupus, Ophiuchus, and Orion. The survey was carried out with the Visible and Infrared Survey Telescope for Astronomy (VISTA), using the VISTA Infrared Camera (VIRCAM), and collected data in the near-infrared passbands J (1.25 μm), H (1.65 μm), and KS (2.15 μm). With a total on-sky exposure time of 49.4h VISIONS covers an area of 650 deg2, it is designed to build an infrared legacy archive with a structure and content similar to the Two Micron All Sky Survey (2MASS) for the screened star-forming regions. Taking place between April 2017 and March 2022, the observations yielded approximately 1.15 million images, which comprise 19 TB of raw data. The observations undertaken within the survey are grouped into three different subsurveys. First, the wide subsurvey comprises shallow, large-scale observations and it has revisited the star-forming complexes six times over the course of its execution. Second, the deep subsurvey of dedicated high-sensitivity observations has collected data on areas with the largest amounts of dust extinction. Third, the control subsurvey includes observations of areas of low-to-negligible dust extinction. Using this strategy, the VISIONS observation program offers multi-epoch position measurements, with the ability to access deeply embedded objects, and it provides a baseline for statistical comparisons and sample completeness – all at the same time. In particular, VISIONS is designed to measure the proper motions of point sources, with a precision of 1 mas yr−1 or better, when complemented with data from the VISTA Hemisphere Survey (VHS). In this way, VISIONS can provide proper motions of complete ensembles of embedded and low-mass objects, including sources inaccessible to the optical ESA Gaia mission. VISIONS will enable the community to address a variety of research topics from a more informed perspective, including the 3D distribution and motion of embedded stars and the nearby interstellar medium, the identification and characterization of young stellar objects, the formation and evolution of embedded stellar clusters and their initial mass function, as well as the characteristics of interstellar dust and the reddening law

VISIONS: The VISTA Star Formation Atlas -- I. Survey overview

© The Authors 2023. Open Access article, published by EDP Sciences, under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0).VISIONS is an ESO public survey of five nearby (d < 500 pc) star-forming molecular cloud complexes that are canonically associated with the constellations of Chamaeleon, Corona Australis, Lupus, Ophiuchus, and Orion. The survey was carried out with VISTA, using VIRCAM, and collected data in the near-infrared passbands J, H, and Ks. With a total on-sky exposure time of 49.4 h VISIONS covers an area of 650 deg$^2$, and it was designed to build an infrared legacy archive similar to that of 2MASS. Taking place between April 2017 and March 2022, the observations yielded approximately 1.15 million images, which comprise 19 TB of raw data. The observations are grouped into three different subsurveys: The wide subsurvey comprises shallow, large-scale observations and has visited the star-forming complexes six times over the course of its execution. The deep subsurvey of dedicated high-sensitivity observations has collected data on the areas with the largest amounts of dust extinction. The control subsurvey includes observations of areas of low-to-negligible dust extinction. Using this strategy, the VISIONS survey offers multi-epoch position measurements, is able to access deeply embedded objects, and provides a baseline for statistical comparisons and sample completeness. In particular, VISIONS is designed to measure the proper motions of point sources with a precision of 1 mas/yr or better, when complemented with data from VHS. Hence, VISIONS can provide proper motions for sources inaccessible to Gaia. VISIONS will enable addressing a range of topics, including the 3D distribution and motion of embedded stars and the nearby interstellar medium, the identification and characterization of young stellar objects, the formation and evolution of embedded stellar clusters and their initial mass function, as well as the characteristics of interstellar dust and the reddening law.Peer reviewe