John M. Eisenberg Patient Safety Awards. System innovation: Veterans Health Administration National Center for Patient Safety

BACKGROUND: In 1998 the Veterans Health Administration (VHA) created the National Center for Patient Safety (NCPS) to lead the effort to reduce adverse events and close calls systemwide. NCPS's aim is to foster a culture of safety in the Department of Veterans Affairs (VA) by developing and providing patient safety programs and delivering standardized tools, methods, and initiatives to the 163 VA facilities. A NOVEL APPROACH: To create a system-oriented approach to patient safety, NCPS looked for models in fields such as aviation, nuclear power, human factors, and safety engineering. Core concepts included a non-punitive approach to patient safety activities that emphasizes systems-based learning, the active seeking out of close calls, which are viewed as opportunities for learning and investigation, and the use of interdisciplinary teams to investigate close calls and adverse events through a root cause analysis (RCA) process. Participation by VA facilities and networks was voluntary. NCPS has always aimed to develop a program that would be applicable both within the VA and beyond. KEY ACTION ITEMS AND RESULTS RELATED TO RCA: NCPS's full patient safety program was tested and implemented throughout the VA system from November 1999 to August 2000. Program components included an RCA system for use by caregivers at the front line, a system for the aggregate review of RCA results, information systems software, alerts and advisories, and cognitive acids. Following program implementation, NCPS saw a 900-fold increase in reporting of close calls of high-priority events, reflecting the level of commitment to the program by VHA leaders and staff.     

A longitudinal test of the investment model: The impact on job satisfaction, job commitment, and turnover of variations in rewards, costs, alternatives, and investments.

A 12-mo longitudinal study of 88 newly hired nurses and junior accountants (mean age of all Ss 24 yrs) tested a series of assumptions from the authors' (see record 1981-31481-001) investment model concerning the determinants of job satisfaction, job commitment, and turnover. In general, greater job satisfaction resulted from high job rewards and low job costs; whereas strong job commitment was produced by high rewards, low costs, poor alternative quality, and large investment size. Whereas the impact of job rewards on satisfaction and commitment remained relatively constant, job costs seemed to exert an increasingly powerful influence over time. Investment size also exerted greater impact on job commitment with the passage of time. Just prior to their leaving, the job commitment of Ss who left was best predicted by a combination of rewards, costs, and alternatives. Ss who stayed and those who left differed from one another with regard to changes over time in each investment model factor—those who left experienced greater decline in rewards, increase in costs, increase in alternative quality, and decrease in investment size than those who stayed. Turnover appeared to be mediated by a decline over time in degree of job commitment. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contraindications to metformin therapy in patients with NIDDM

OBJECTIVE: Treatment with metformin is occasionally associated with the development of severe lactic acidosis. However, this is usually observed in patients with major contraindications to the drug. In this study, we aimed to determine the prevalence of conditions currently regarded as either contraindications or cautions to the use of metformin in patients with NIDDM. RESEARCH DESIGN AND METHODS: The case notes of metformin-treated NIDDM patients (mean age 62 years) attending a United Kingdom university hospital diabetes clinic over a 3-month period were reviewed according to criteria reflecting a pragmatic view of current prescribing recommendations. RESULTS: Of 89 consecutive patients whose notes could be evaluated in detail, only 41 (46%) had no contraindications or cautions to metformin whatsoever. Concomitant chronic disorders associated with a potentially increased risk of hyperlactatemia were renal impairment (n = 2; plasma creatinine concentrations 1.7 and 2.3 mg/dl, respectively), cardiac failure (n = 2), and chronic liver disease (n = 2). Other potentially relevant disorders included ischemic heart disease (n = 20), clinical proteinuria (n = 14), peripheral vascular disease (n = 22), and pulmonary disease (n = 7). Multiple conditions (i.e., two, three, or four) were present in eight, five, and one patient(s), respectively. CONCLUSIONS: More than half the patients in our series had concomitant conditions or complications conventionally regarded as cautions or contraindications to metformin; approximately 10% had a multiplicity of such conditions. Regular surveillance is necessary to detect the development of complications such as renal impairment. Vigilance is also required in view of the increased risk of major intercurrent illnesses, which may independently disturb lactate metabolism in patients with NIDDM. Metformin should be withdrawn promptly under such circumstances.     

Novel diffusion cell for in vitro transdermal permeation, compatible with automated dynamic sampling

The development of a new diffusion cell for in vitro transdermal permeation is described. The so-called Kelder cells were used in combination with the ASPEC system (Automatic Sample Preparation with Extraction Columns), which is designed for the automation of solid-extractions (SPE). Instead of SPE columns, 20 Kelder cells were placed in the racks. This allowed automatic sampling of up to 20 cells for 24 h in a dynamic mode. The cells consist of an inlet compartment, a donor compartment and a receptor compartment. The size and the depth of the inlet compartment were important to avoid entrapment of air bubbles in the receptor compartment. The Kelder cells mimic blood flow beneath the skin by replacement of the permeating drug every 2 min. Hence sink condition are more easily maintained than with the static Franz diffusion cell. The performance of the cells was tested with permeation experiments using atropine as a model drug permeating through an artificial membrane (Silastic). The use of this skin model minimized the variability in permeation of atropine as compared with human skin.     

Navigating personal and relational concerns: The quest for equilibrium.

The authors' personal-relational equilibrium model suggests that people come to seek equilibrium in their dedication to personal and relational concerns in that these 2 important needs cannot always be gratified simultaneously. The authors proposed that the experience of personal-relational disequilibrium motivates attempts to restore equilibrium and that achieving equilibrium promotes life satisfaction. Four studies revealed good support for the model. In Study 1, a manipulation of anticipated future disequilibrium (vs. equilibrium) as a result of overdedication to either the personal or relational domain caused reduced motivation to address concerns in that domain and increased motivation toward the complementary domain. In Study 2, narratives describing disequilibrium experiences (vs. equilibrium experiences) exhibited increased motivation to restore equilibrium and reduced life satisfaction. In Study 3, diary reports of everyday disequilibrium were associated with increased same-day motivation to restore equilibrium, reduced same-day life satisfaction, and increased next-day dedication of effort to the complementary domain. In Study 4, experiences of disequilibrium predicted reduced well-being 6 months later. Collectively, these findings extend knowledge of how people regulate themselves toward equilibrium in pursuing 2 fundamental human concerns. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mobility fluctuation1/f noise in silicon p+-n-p transistors

A study of the current dependence of base 1/f noise and of collector 1/f noise in p⁺-n-p transistors shows that the former is most likely of the mobility fluctuation 1/f noise type and that the latter is most probably not of that type. The current dependence of 1/f noise in transistors is a powerful tool in the interpretation of the noise.     

Interkey timing in piano performance and typing

In typing, when the fingers executing two successive movements are on the same hand, the time between keystrokes is longer than when the fingers are on different hands. Biomechanical limitations of the hands are thought to account for this difference. The generality of this finding was explored by investigating skilled pianists' performance of two successive notes. Experiment 1 failed to find comparable differences in timing as a function of the hands involved. Experiment 2, employing both a piano production and a typing task, replicated the previous piano performance results, and revealed that the timing differences in typing were limited to letter sequences requiring fore-aft and lateral finger movements. Experiment 3 extended this finding to piano performance. Together, these findings clarify the nature of biomechanical constraints on skilled manual performance.     

Consumer acceptance of high-fibre muffins and rusks baked with red palm olein

The acceptance of, preference for and consumption intent for high‐fibre muffins and/or rusks baked with either red palm olein (RPO) or sunflower oil (SFO, as control) were evaluated by two consumer groups of 144 and 67 consumers, respectively, in order to determine the possibility of their successful inclusion as carriers for oils in a subsequent nutrition intervention trial. A five‐point hedonic and food action rating scale was used for sensory evaluation. SFO muffins and rusks scored significantly higher than RPO products on a number of hedonic dimensions and were thus more acceptable to the average consumer. Sensory attributes of SFO and RPO products received high scores by consumers from both groups (≥4.0 on five‐point scale), and consumers intended to eat them often (at least one per day). The RPO products were satisfactory in terms of acceptance and complied with requirements for use in the subsequent nutrition intervention trial.