Lessons from the TAPS study - Reducing the risk of patient harm

The Threats to Australian Patient Safety (TAPS) Study collected 648 anonymous reports about threats to patient safety from a representative random sample of Australian general practitioners. These contained any events the GPs felt should not have happened and would not want to happen again, regardless of who was at fault or the outcome of the event. This series of articles presents clinical lessons resulting from the TAPS study.2 page(s

Spider Silk and Amyloid Fibrils: A Structural Comparison

Although spider silks have been studied for decades, the assembly properties of the underlying silk proteins have still not been unravelled. Previously, the detection of amyloid-like nanofibrils in the spider's silk gland suggested their involvement in the assembly process. Recombinantly produced spider silk also self-assembles into nanofibrils. In order to investigate the structural properties of such silk nanofibrils in more detail, they have been compared to amyloid-like fibrils to highlight structural similarities

Patient safety events reported in general practice: a taxonomy

Objective: To develop a taxonomy describing patient safety events in general practice from reports submitted by a random representative sample of general practitioners (GPs), and to determine proportions of reported event types. Design: 433 reports received by the Threats to Australian Patient Safety (TAPS) study were analysed by three investigating GPs, classifying event types contained. Agreement between investigators was recorded as the taxonomy developed. Setting and participants: 84 volunteers from a random sample of 320 GPs, previously shown to be representative of 4666 GPs in New South Wales, Australia. Main outcome measures: Taxonomy, agreement of investigators coding, proportions of error types. Results: A three-level taxonomy resulted. At the first level, errors relating to the processes of healthcare (type 1; n = 365 (69.5%)) were more common than those relating to deficiencies in the knowledge and skills of health professionals (type 2; n = 160 (30.5%)). At the second level, five type 1 themes were identified: healthcare systems (n = 112 (21.3%)); investigations (n = 65 (12.4%)); medications (n = 107 (20.4%)); other treatments (n = 13 (2.5%)); and communication (n = 68 (12.9%)). Two type 2 themes were identified: diagnosis (n = 62 (11.8%)) and management (n = 98 (18.7%)). The third level comprised 35 descriptors of the themes. Good inter-coder agreement was demonstrated with an overall κ score of 0.66. A least two out of three investigators independently agreed on event classification in 92% of cases. Conclusions: The proposed taxonomy for reported events in general practice provides a comprehensible tool for clinicians describing threats to patient safety, and could be built into reporting systems to remove difficulties arising from coder interpretation of events.5 page(s

The Threats to Australian Patient Safety (TAPS) study: incidence of reported errors in general practice

OBJECTIVE: To determine the incidence of errors anonymously reported by general practitioners in NSW. DESIGN: The Threats to Australian Patient Safety (TAPS) study used anonymous reporting of errors by GPs via a secure web-based questionnaire for 12 months from October 2003. SETTING: General practices in NSW from three groupings: major urban centres (RRMA 1), large regional areas (RRMA 2-3), and rural and remote areas (RRMA 4-7). PARTICIPANTS: 84 GPs from a stratified random sample of the population of 4666 NSW GPs - 41 (49%) from RRMA 1, 22 (26%) from RRMA 2-3, and 21 (25%) from RRMA 4-7. Participants were representative of the GP source population of 4666 doctors in NSW (Medicare items billed, participant age and sex). MAIN OUTCOME MEASURES: Total number of error reports and incidence of reported errors per Medicare patient encounter item and per patient seen per year. RESULTS: 84 GPs submitted 418 error reports, claimed 490 864 Medicare patient encounter items, and saw 166 569 individual patients over 12 months. The incidence of reported error per Medicare patient encounter item per year was 0.078% (95% CI, 0.076%-0.080%). The incidence of reported errors per patient seen per year was 0.240% (95% CI, 0.235%-0.245%). No significant difference was seen in error reporting frequency between RRMA groupings. CONCLUSIONS: This is the first study describing the incidence of GP-reported errors in a representative sample. When an anonymous reporting system is provided, about one error is reported for every 1000 Medicare items related to patient encounters billed, and about two errors are reported for every 1000 individual patients seen by a GP.4 page(s

A função da nomeação oral sobre comportamentos emergentes de leitura e escrita ensinados por computador The oral naming function on emergencies behaviors of reading and spelling teaching by computer

Os métodos de alfabetização utilizados em sala de aula não têm diminuído os índices de repetência nas séries iniciais. Por essa razão, o presente trabalho enfocou o comportamento de leitura e escrita como objeto de estudo. Para isso, utilizou-se o programa Mestre@ (Goyos & Almeida, 1994). Os objetivos foram o ensino de um repertório de leitura e escrita, composto de palavras regularmente utilizadas nas séries iniciais, e o desenvolvimento e sistematização de um procedimento de ensino, via software. O procedimento utilizado foi o de exclusão. Foi solicitada a um grupo de alunos, a nomeação oral do estímulo modelo antes de escolher e/ou montar as palavras que estavam sendo ensinadas. Os resultados indicam uma alta probabilidade da aprendizagem sem erro das relações ensinadas bem como leitura das palavras de generalização, além de mostrar efeitos diferenciais entre os grupos, isto é, facilitação para o grupo sem o procedimento de nomeação oral.<br>The literate methods used in classroom haven't decreased the indexes of repetition in the initial grades. On that score, the present study focused on the behavior of reading and spelling. For this, the program Mestre@ (Goyos & Almeida, 1994) was used. The goals were the teaching of a repertoire of reading and spelling, made up of words regularly used in the initial grades, and the development and systematization of a teaching procedure, through software. The procedure used was the match-to-sample. The oral naming of the sample stimulus by a group of students was required, before they could choose the words that were being taught. The results indicate a high probability of the learning without error of the teaching relations as well as of the reading of the generalization words. In addition, the findings show differential effects among the groups, that is to say, facilitation to the group without the oral naming procedure