A Neural Attention Model for Categorizing Patient Safety Events

Medical errors are leading causes of death in the US and as such, prevention of these errors is paramount to promoting health care. Patient Safety Event reports are narratives describing potential adverse events to the patients and are important in identifying and preventing medical errors. We present a neural network architecture for identifying the type of safety events which is the first step in understanding these narratives. Our proposed model is based on a soft neural attention model to improve the effectiveness of encoding long sequences. Empirical results on two large-scale real-world datasets of patient safety reports demonstrate the effectiveness of our method with significant improvements over existing methods.Comment: ECIR 201

Discrepant perceptions of communication, teamwork and situation awareness among surgical team members

Objective To assess surgical team members’ differences in perception of non-technical skills. Design Questionnaire design. Setting Operating theatres (OTs) at one university hospital, three teaching hospitals and one general hospital in the Netherlands. Participants Sixty-six surgeons, 97 OT nurses, 18 anaesthetists and 40 nurse anaesthetists. Methods All surgical team members, of five hospitals, were asked to complete a questionnaire and state their opinion on the current state of communication, teamwork and situation awareness at the OT. Results Ratings for ‘communication’ were significantly different, particularly between surgeons and all other team members (P ? 0.001). The ratings for ‘teamwork’ differed significantly between all team members (P ? 0.005). Within ‘situation awareness’ significant differences were mainly observed for ‘gathering information’ between surgeons and other team members (P < 0.001). Finally, 72–90% of anaesthetists, OT nurses and nurse anaesthetists rated routine team briefings and debriefings as inadequate. Conclusions This study shows discrepancies on many aspects in perception between surgeons and other surgical team members concerning communication, teamwork and situation awareness. Future research needs to ascertain whether these discrepancies are linked to greater risk of adverse events or to process as well as systems failures. Establishing this link would support implementation and use of complex team interventions that intervene at multiple levels of the healthcare systemIndustrial Design Engineerin

A surgical team simulation to improve teamwork and communication across two continents: ViSIOT™ proof-of-concept study

Background: Team communication in operating rooms is problematic worldwide, and can negatively impact patient safety. Although initiatives such as the World Health Organization’s Surgical Safety Checklist have been introduced to improve communication, patient safety continues to be compromised globally, warranting the development of new interventions. Video-based social science methods have contributed to the study of communication in UK ORs through actual observations of surgical teams in practice. Drawing on this, the authors have developed a surgical team simulation-training model (ViSIOT™). A proof-of-concept study was conducted in the UK and USA to assess if the ViSIOT™ simulation-training has applicability and acceptability beyond the UK. Methods: ViSIOT™ training was conducted at two simulation centers in the UK and USA over a 10-month period. All surgical team participants completed a questionnaire (that assessed design, education, satisfaction and self-confidence in relation to the training). Descriptive and inferential statistics were performed for the quantitative data and thematic analysis was conducted for the qualitative data. Results: There was strong agreement from all participants in terms of their perception of the course across all sub-sections measured. Nine themes from the qualitative data were identified. The two countries shared most themes, however, some emerged that were unique to each country. Conclusions: Practical developments in the course design, technology and recruitment were identified. Evidence of the course applicability in the USA provides further affirmation of the universal need for team communication training within ORs. Further studies are required to assess its effectiveness in improving communication in OR practice

Needlestick and sharps injuries among health care workers at public tertiary hospitals in an urban community in Mongolia

<p>Abstract</p> <p>Background</p> <p>Needlestick and sharps injuries (NSSIs) are one of the major risk factors for blood-borne infections at healthcare facilities. This study examines the current situation of NSSIs among health care workers at public tertiary hospitals in an urban community in Mongolia and explores strategies for the prevention of these injuries.</p> <p>Findings</p> <p>A survey of 621 health care workers was undertaken in two public tertiary hospitals in Ulaanbaatar, Mongolia, in July 2006. A semi-structured and self-administered questionnaire was distributed to study injection practices and the occurrence of NSSIs. A multiple logistic regression analysis was performed to investigate factors associated with experiencing NSSIs. Among the 435 healthcare workers who returned a completed questionnaire, the incidence of NSSIs during the previous 3 months was 38.4%. Health care workers were more likely to report NSSIs if they worked longer than 35 hours per week (odds ratio, OR: 2.47; 95% confidence interval, CI: 1.31-4.66) and administered more than 10 injections per day (OR: 4.76; 95% CI: 1.97-11.49). The likelihood of self-reporting NSSIs significantly decreased if health care workers adhered to universal precautions (OR: 0.34; 95% CI: 0.17-0.68).</p> <p>Conclusions</p> <p>NSSIs are a common public health problem at public tertiary hospitals in Mongolia. The promotion of adequate working conditions, elimination of excessive injection use, and adherence to universal precautions will be important for the future control of potential infections with blood-borne pathogens due to occupational exposures to sharps in this setting.</p

Obesity and Type 2 Diabetes: What Can Be Unified and What Needs to Be Individualized?

Data show that the insights that improve obesity prevention and treatment will almost certainly benefit the incidence and care of type 2 diabetes

Frailty in primary care: a review of its conceptualization and implications for practice

Frail, older patients pose a challenge to the primary care physician who may often feel overwhelmed by their complex presentation and tenuous health status. At the same time, family physicians are ideally suited to incorporate the concept of frailty into their practice. They have the propensity and skill set that lends itself to patient-centred care, taking into account the individual subtleties of the patient's health within their social context. Tools to identify frailty in the primary care setting are still in the preliminary stages of development. Even so, some practical measures can be taken to recognize frailty in clinical practice and begin to address how its recognition may impact clinical care. This review seeks to address how frailty is recognised and managed, especially in the realm of primary care

Age-Related Changes of Myelin Basic Protein in Mouse and Human Auditory Nerve

Age-related hearing loss (presbyacusis) is the most common type of hearing impairment. One of the most consistent pathological changes seen in presbyacusis is the loss of spiral ganglion neurons (SGNs). Defining the cellular and molecular basis of SGN degeneration in the human inner ear is critical to gaining a better understanding of the pathophysiology of presbyacusis. However, information on age-related cellular and molecular alterations in the human spiral ganglion remains scant, owing to the very limited availably of human specimens suitable for high resolution morphological and molecular analysis. This study aimed at defining age-related alterations in the auditory nerve in human temporal bones and determining if immunostaining for myelin basic protein (MBP) can be used as an alternative approach to electron microscopy for evaluating myelin degeneration. For comparative purposes, we evaluated ultrastructural alternations and changes in MBP immunostaining in aging CBA/CaJ mice. We then examined 13 temporal bones from 10 human donors, including 4 adults aged 38–46 years (middle-aged group) and 6 adults aged 63–91 years (older group). Similar to the mouse, intense immunostaining of MBP was present throughout the auditory nerve of the middle-aged human donors. Significant declines in MBP immunoreactivity and losses of MBP+ auditory nerve fibers were observed in the spiral ganglia of both the older human and aged mouse ears. This study demonstrates that immunostaining for MBP in combination with confocal microscopy provides a sensitive, reliable, and efficient method for assessing alterations of myelin sheaths in the auditory nerve. The results also suggest that myelin degeneration may play a critical role in the SGN loss and the subsequent decline of the auditory nerve function in presbyacusis