A Web-based program for implementing evidence-based patient safety recommendations

BACKGROUND: In response to increasing national concerns about medical safety, product developers from a health services research and software group recently created a commercial Web-based program to address a wide variety of patient safety issues in the acute care setting. They also wanted to provide a program with credible, referenced, and up-to-date content, not just a technology infrastructure for reporting errors. SAFETY OPTIMIZER: This Web-based program, which has evolved over time, now features seven modules for assessing organizational risk and for implementing strategies to reduce risk. The Literature Module features detailed synopses that are graded and organized into summary statements to provide recommendations for improving patient safety. The Implementation/Tracking Module includes numerous risk-reduction strategies. The Incident Reporting Module enables the collection of data at the point of care on a variety of incidents, using either paper-based or on-line forms. Other modules offer opportunities to assess adherence to JCAHO patient safety standards, forecast the benefits of certain evidence-based guidelines, evaluate staff competency, and obtain information from a variety of key safety Web sites. EXPERIENCE TO DATE: The program is in use at more than 30 health care organization facilities and systems. It is still too early to provide quantitative data on the impact of this program on patient safety. CONCLUSIONS: It is hoped that vendor solutions such as the one described in this article will help organizations develop a practical and effective framework for addressing the wide range of issues in patient safety.     

Assessing clinical pathways use in a community hospital: it depends on what "use" means

BACKGROUND: Many benefits have been associated with the use of clinical pathways, yet developing them can be costly, and implementing them is not always successful. A 300-bed Midwestern community hospital began a clinical pathways program in 1995, and by fall 1998, 15 pathways were in various stages of implementation, with 3 under development. Many challenges had been encountered, but hospital leaders were eager to find ways to increase pathway use. METHODS: A qualitative case study design was used to investigate four clinical pathways, two perceived as being "used" and two that were perceived as "not used". Each pathway was analyzed as a separate case, followed by cross-case analysis. Qualitative data were collected in 65 semistructured interviews with administrators, physicians, physicians' office staff, nurses, and allied health professionals at the hospital. Data were also collected through observation and document analysis. RESULTS: The two used pathways had been introduced as part of a larger change in care, whereas the two pathways not used had been introduced as stand-alone innovations. Confusing and inadequately developed aspects of the hospital's clinical pathways program included its purposes, the definition of pathway use, pathway procedures, accountability, education, and incentives. A new case management department, ongoing administrative support, and a sophisticated medical information system were viewed as supports for continued growth in the program. CONCLUSIONS: Implementation of clinical pathways was delayed and complicated by the varied perceptions of the program among stakeholders. Lack of clarity and consistency in how information about the program was communicated made it difficult for clinicians to develop a shared understanding of clinical pathways.     

Digital refraction distortion correction with an astigmatic coherence sensor

We demonstrate the sensing and correction of an isoplanatic refractive distortion (not lens aberrations), using the complete measurement of the partially coherent field in an aperture that the previously described astigmatic coherence sensor provides. Isoplanatic distortions, and in general distortions that do not cause energy loss, maintain the orthogonality of the coherent modes. We use the fact that a common distortion will occur to all coherent modes to separate the distortion from the source behind it, rather than requiring a reference source at a different wavelength. Digital deconvolution was performed on the full four-dimensional partially coherent field for simultaneously computing the distortion and the source intensity distribution.     

Use of a fixed-base driving simulator to evaluate the effects of experience and PC-based risk awareness training on drivers' decisions

Driver education classes were once seen as a remedy for young drivers' overinvolvement in crashes, but research results from the early 1970s were disappointing. Few changes in the content or methods of instruction occurred until recently, but this could change rapidly. Personal computers (PCs) can now present videos or photorealistic simulations of risky, cognitively demanding traffic scenarios that require quick responses without putting the participant at risk. As such programs proliferate, evaluating their effectiveness poses a major challenge. We report the use of a fixed-base driving simulator to study the effects of both experience on the road and PC-based risk awareness training on younger drivers' part-task simulator driving performance in risky traffic scenarios. We ran three groups of drivers on the simulator: one group first trained on the PC (younger, inexperienced drivers) and two groups who received no PC training (younger, inexperienced and experienced drivers). Overall, the younger, inexperienced drivers who were trained on a PC operated their vehicles in risky scenarios in ways that differed measurably from those of the untrained younger, inexperienced drivers and, more important, in ways that we believe would decrease their exposure to risk considering that, on average, their behavior was more similar to the behavior of the untrained, experienced drivers. More research is needed to demonstrate whether these findings apply on the open road to the larger population of younger drivers. However, at least initially, the research suggests that PC-based risk awareness training programs have the potential to reduce the high crash rate among younger, inexperienced drivers.     

Testing Self-Similar Networks

A hard problem in network testing is verifying the correctness of a class of networks, as well as the actual networks under test. In practice, at most a few networks (sometimes only one) are actually tested. Thus an important question is how to select one or more networks that are sufficiently representative to apply the results to a class of networks. We present a model-based technique for selecting a representative network. The central theorem establishes that the representative network displays any faults present in any network of the class. This paper introduces the concept of “self-similarity,” which is used to select the network, and presents the results of an experiment in testing one class of networks.     

Relation of emotion-related regulation to children's social competence: A longitudinal study.

The differential relations of children's emotion-related regulation (i.e., effortful control and impulsivity) to their personality resiliency, adult-rated popularity, and social competence were examined in children who were 4.5-7.9 years old and who were remeasured 2 years later. Parents and teachers reported on all constructs, and children's attentional persistence was observed. Structural equation modeling was used to test the mediating role of resiliency on the relations between regulation/control and popularity using two-wave longitudinal data. The results provide some evidence of the mediating role of resiliency in the relations between effortful control and popularity, provide some evidence of bidirectional effects, and also buttress the view that emotional regulation should be differentiated into effortful and reactive forms of control. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intravenous cocaine discrimination in humans.

Ten cocaine-dependent participants were trained to discriminate between intravenous saline and 20 mg/70 kg cocaine. During the first session, saline and cocaine injections were alternated twice, with each separated by 1 hr. The injections were identified by letter codes. During the next 3 sessions, 12 trials were conducted, with saline and cocaine administered 6 times each in pseudorandom order. Thirty minutes following each injection, participants were asked to identify the injection by letter code. Seven of the 10 learned the discrimination (at least 10 trials correct). To evaluate sensitivity, the investigators tested participants with different doses of cocaine in test sessions. In the next phase, methamphetamine (5 and 10 mg/70 kg) and pentobarbital (50 and 100 mg/70 kg) were given intravenously during test sessions to determine whether the discrimination exhibited pharmacological class selectivity. During the evaluation of sensitivity and selectivity, training sessions were interspersed. As dose of cocaine increased, the number of participants identifying the test dose as cocaine increased, demonstrating sensitivity. The higher doses of methamphetamine and pentobarbital substituted for cocaine. The physiological and subjective effects of cocaine and methamphetamine were stimulant-like and dose related. Pentobarbital produced no physiological changes but increased Visual Analog Scale ratings of Sedation, Good Drug Effect, and High. This failure to demonstrate pharmacological selectivity may be related to participants' learning a drug-vs.-no-drug discrimination, and thus it may be necessary to alter training procedures in future studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol-related and alcohol-free activity participation and enjoyment among college students: A behavioral theories of choice analysis.

College student alcohol abuse remains a significant public health problem, and there is a need for theory-driven and empirically based models to guide prevention efforts. Behavioral theories of choice assume that the decision to consume alcohol is influenced by the relative value of alcohol versus other available activities. In the present study, a sample of college student drinkers (N=108; 56% female, 44% male) who had previously completed a mandatory alcohol intervention completed a measure of alcohol-related and alcohol-free activity participation and enjoyment. The goals of the study were to examine the influence of drinking quantity and contextual variables on activity enjoyment and to identify enjoyable alcohol-free activities that take place on evenings when students might otherwise be drinking. Overall, students found alcohol-related activities more enjoyable than alcohol-free activities, and drinking quantity was positively related to enjoyment. However, alcohol-free activities such as watching movies, going to the theater or museums, going to bars or parties, hanging out with friends, eating at restaurants, and engaging in creative activity were generally as enjoyable as drinking. Alcohol-free activities that included peers or dates were more enjoyable than solitary activities. Men were less likely to engage in alcohol-free activities that included peers and reported less enjoyment related to alcohol-free activities than did women. Further research is required to identify procedures for increasing participation in alcohol-free activities and to determine whether increased alcohol-free activity participation results in decreased alcohol consumption. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exploiting nonacoustic sensors for speech encoding

The intelligibility of speech transmitted through low-rate coders is severely degraded when high levels of acoustic noise are present in the acoustic environment. Recent advances in nonacoustic sensors, including microwave radar, skin vibration, and bone conduction sensors, provide the exciting possibility of both glottal excitation and, more generally, vocal tract measurements that are relatively immune to acoustic disturbances and can supplement the acoustic speech waveform. We are currently investigating methods of combining the output of these sensors for use in low-rate encoding according to their capability in representing specific speech characteristics in different frequency bands. Nonacoustic sensors have the ability to reveal certain speech attributes lost in the noisy acoustic signal; for example, low-energy consonant voice bars, nasality, and glottalized excitation. By fusing nonacoustic low-frequency and pitch content with acoustic-microphone content, we have achieved significant intelligibility performance gains using the DRT across a variety of environments over the government standard 2400-bps MELPe coder. By fusing quantized high-band 4-to-8-kHz speech, requiring only an additional 116 bps, we obtain further DRT performance gains by exploiting the ear's insensitivity to fine spectral detail in this frequency region.     

An empirical examination of a process-oriented IT business success model

The value of information technology (IT) to modern organizations is almost undeniable. However, the determination of that value has been elusive in research and practice. We used a process-oriented research model developed using two streams of IT research to examine the value of IT in business organizations. One stream is characterized by examining how IT and non-IT variables affect other so-called IT success variables. The second stream is commonly referred to as IT business value, defined as the contribution of IT to firm performance. The resulting research model is referred to in our paper as the IT business success model. Data was collected from 225 top IS executives in fairly large organizations to empirically examine several hypotheses derived from theory concerning the causal nature of the IT business success model. A set of measures for the IT business success model was developed through an intense investigation of the IT literature. The measures were tested for validity and reliability using confirmatory factor analysis. The hypotheses that resulted from past research and conceptually illustrated in the research model were assessed using structural equation analysis. The implications of these findings and the limitations of the study are discussed in an effort to contribute to building a process-oriented theory base for IT business success at the organizational level of analysis.