271 research outputs found
Patient Safety in Pediatrics: a Developing Discipline
__Abstract__
The publication of the breakthrough report “To Err is Human” by the Institute of Medicine was the
launch of patient safety initiatives all over the world. In the intensive care unit (ICU) of the Erasmus
MC-Sophia Children’s Hospital this resulted in the institution of a multimodal patient safety management
system under the name Safety First in 2005. This system now includes nine major elements,
representing monitoring and intervention activities. In this thesis we report on the results and the
implementation of the patient safety management system called Safety First.
__Outline of this thesis:__
In part I the concept of patient safety and the Safety First project are introduced. The rationale for
selecting the elements of the patient safety management system is explained. As preventable mortality
and morbidity are the public focus as outcome parameters for quality and safety of care, we
have studied very long stay patients in our ICU (chapter 2). The goal of this study was to determine
characteristics and mortality in these patients as well as modes of death. Chapter 3 presents an evaluation
of potentially preventable deaths in our ICU. An important question was whether five years
of patient safety efforts had resulted in fewer potentially preventable deaths.
Part II reflects on the difficulties in monitoring adverse events. In chapter 4 we present numbers and
types of adverse events identified with real time physicians’ registration during a 3-month period in
general pediatric practice. The next chapter is a study into adverse events in the surgical pediatric
ICU in a 2-year period. We combined the physicians’ registration with the Trigger Tool methodology
as developed by the Institute for Healthcare, Boston, USA. The goals were to determine the rate and
nature of the adverse events and to compare the two methods.
In part III a number of elements of Safety First are described, as well as other studies into patient
safety issues relevant to bedside ICU care. Chapter 6 brings the results of critical incident analysis
with a focus on the factors contributing to the incident and the resultant recommendations. The
next study evaluated the availability and reliability of drug formularies used in our ICU, which are
crucial in safe drug prescription. In chapter 8 we discuss the safety of routine MRI scans in preterm
infants at 30 weeks gestational age, as reflected by safety incidents and adverse events. In the next
chapter, safety focused Mortality and Morbidity conference reports were scrutinized for numbers
and types of recommendations stemming from these meetings. Chapter 10 is a study about nursing
protocol violations established with the Critical Nursing Situation Index.
Part IV describes a study of safety culture in the ICU, as it emerged from a safety attitude questionnaire
administered to all staff. We aimed to compare findings to benchmark data and explore any
deficiencies.
In the general discussion in part V the results of the studies are commented on and future directions
are given, including guidelines for optimal implementation of a patient safety management system
and future benchmarking
De succesfactoren voor een geslaagde productinnovatie : de theorie gekoppeld aan een praktijkvoorbeeld
Productinnovatie is belangrijk voor de marketing van tuinbouwbedrijven. Productinnovatie is kostbaar en risicovol maar gelukkig zijn succesfactoren voor nieuwe producten bekend: een superieur, innovatief product dat gebruik maakt van technologische en marketingvaardigheden van het bedrijf en dat tot stand komt in een marktgericht ontwikkelingsproces. Hoewel succesfactoren het succes van een productinnovatie goed voorspellen, circuleren er allerlei smoezen om de succesfactoren niet toe te passen. De ervaringen van Boomkwekerij Van der Starre laten zien dat succesvolle productinnovatie mogelijk is wanneer de succesfactoren worden toegepas
Poëzietatoeages in de klas
In haar bijdrage neemt Kila van der Starre je mee naar de fascinerende wereld van poëzietatoeages en de toepassingsmogelijkheden van dat fenomeen in de klas
Treatment duration and prognostics in febrile urinary tract infection
Aim of this thesis was to provide evidence for the clinical implication of biomarkers in blood and urine, as well as genetic markers, for the prediction of the severity and course of febrile UTI. Furthermore, this thesis focused on optimization of antimicrobial treatment of febrile UTI. The main results are: 1. Recent hospitalization, indwelling urinary catheter and especially individual fluoroquinolone (FQ) use are independent risk factors for a FQ-resistant Escherichia coli febrile UTI. 2. Women with febrile UTI, including postmenopausal women and those with comorbidities, can be safely and successfully treated with a 7-day course of oral ciprofloxacin. In men, however, treatment duration should be at least 14 days. 3. Diabetes mellitus does not affect the clinical presentation and course of febrile UTI; concurrent illnesses and higher age of the diabetic population attribute to a more complicated course. 4. MR-proADM more accurately predicts a complicated course of disease than currently available inflammatory biomarkers. Importantly, biomarkers derived directly from host defense mechanisms are not suitable to distinguish between febrile UTI patients with and without bacteremia. 5. MP-TF activity is related to disease severity and bacteraemia in febrile E. coli UTI and may contribute to the prothrombotic state in gram-negative sepsis.UBL - phd migration 201
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