Reducing adverse drug events: lessons from a breakthrough series collaborative

BACKGROUND: In January 1996, 38 hospitals and health care organizations (for a total of 40 hospitals) in the United States came together in an Institute for Healthcare Improvement (IHI; Boston) Breakthrough Series collaborative to reduce adverse drug events-injuries related to the use or nonuse of medications. METHODS: The participants were taught the Model for Improvement, a method for rapid-cycle change and evaluation, and were then coached on how to identify their own problem areas and develop changes in practice for rapid-cycle testing. These changes could be implementation of one or more known medication error prevention practices or new practices developed. RESULTS: During a 15-month period the 40 hospitals conducted a total of 739 tests of changes. Process changes accounted for 63% of the cycles; the remainder consisted of preliminary data gathering, consensus-building, or education cycles. Eight types of changes were implemented by seven or more hospitals, with a success rate of 70%. These changes included non-punitive reporting, ensuring documentation of allergy information, standardizing medication administration times, and implementing chemotherapy protocols. DISCUSSION: Success in making significant changes was associated with strong leadership, effective processes, and appropriate choice of intervention. Successful teams were able to define, clearly state, and relentlessly pursue their aims, and then chose practical interventions and moved early into changing a process. They did not spend months collecting data before beginning a change. Changes that were most successful were those that attempted to change processes, not people. Health care organizations committed to patient safety need not regard current performance limits as inevitable.     

Developing nursing's future role: a challenge for the millennium: 1

Over the past decade health care in general and nursing in particular have experienced a period of unprecedented change resulting from a variety of factors including demography, advances in technology and the introduction of differing service delivery systems. For nursing this has created a number of tensions, especially between professional aspirations and the demands of a new managerial culture. Many nurses have found themselves torn between the push towards the ideal of individualized holistic care and the reality of resource constrained environments. The new White Paper 'The New NHS: Modern, Dependable' (Secretary of State for Health, 1997) heralds a move away from the 'short termism' of the internal market towards a partnership model of integrated care. It also reaffirms the Government's commitment to further develop the role of the nurse. This article, the first of two, considers the challenges nurses face in responding to a managerial agenda while simultaneously maintaining the development of the nursing profession. The opportunities afforded by the recent White Paper are identified and the need to address a number of current tensions are highlighted. Developments at the Northern General Hospital in Sheffield are briefly described, with the results of a major survey being presented in the second article.     

In vitro 2,3,7,8-tetrachlorodibenzo-p-dioxin interference with the anterior pituitary hormone adrenocorticortropin

Pharmacological effects of acute treatment with venlafaxine (VEN), a clinically active antidepressant [a noradrenaline (NA) and 5-hydroxytryptamine (5-HT) reuptake inhibitor without any affinity for neurotransmitter receptors] were studied in mice and rats. VEN inhibited the reserpine- or apomorphine-induced hypothermia and enhanced the L-5-HTP-induced head twitches in mice. It reduced the immobility time in Porsolt's test in mice and rats, but either did not change the locomotor activity (mice) or decreased it (rats). VEN reduced the locomotor hyperactivity induced by amphetamine (AMP), apomorphine (APO) and quinpirole (QUI), as well as the APO-induced stereotypy; the stereotypy induced by AMP in rats was prolonged. VEN neither changed the clonidine-induced aggressiveness in mice nor the behavioral syndrome induced by oxotremorine in rats. The obtained results indicate that VEN, given acutely, shows a pharmacological profile similar to that of tricyclic NA and 5-HT reuptake inhibitors. In contrast to the antidepressants mentioned above, VEN does not exhibit an alpha 1-adrenolytic or a cholinolytic activity (in vivo tests).     

Survival Skills for The is Professional

IS professionals can only dream of the days when technical brilliance alone was enough to ensure a successful career. Now business acumen and a strong understanding of customer expectations are vital to long-term career survival. Based on their study of 75 experienced IS professionals, the authors present guidelines for fostering the development of customer-oriented IS professionals.     

Long-term effects of behavior therapy: A 12-month follow-up.

19 female undergraduates who underwent various behavioral treatments designed to reduce a specific fear were paid to return for follow-up 1 yr. later. In general, treated Ss' rat fears were less intense 1 yr. after treatment than they had been prior to treatment, with those treated by systematic desensitization slightly less fearful than those treated with "rational therapy." Subsequently, the desensitized Ss eliminated a snake fear by themselves, but the effects of this self-administered desensitization were not maintained. Additionally, 6 children treated by operant conditioning techniques for various problems were reevaluated 1 yr. later. All behavior change was maintained, but only those who had graduated to social reinforcement showed additional improvement. No evidence for symptom substitution was obtained from either group of Ss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preparation of3H-phosphatidylmyoinositol withKloeckera brevis

The growth ofKloeckera brevis in the presence of uniformly tritiated myoinositol is described. The major radioactive lipid isolated from the cells is³H-phosphatidylmyoinositol, labeled exclusively in the myoinositol moiety. Chromatographic methods for purifying³H-phosphatidylmyoinositol, free from other labeled lipids, are described, and the use of this labeled lipid as a precursor in studying enzymatic synthesis of complex inositol lipids is demonstrated.     

SPUDT filters for the 2.45 GHz ISM band

Filters based on using single-phase, unidirectional transducers (SPUDT) consisting of lambda/4 and wider electrodes are presented. The design variants exploit the significant difference between the reflectivity of short-circuited lambda/4 electrodes and that of floating wide electrodes on 128 degree lithium niobate (LiNbO3). The surface acoustic wave (SAW) devices operating at 2.45 GHz have critical dimensions of about 0.3-0.4 microm, accessible to standard optical lithography. When matched, the fabricated SPUDT filters exhibit minimum insertion losses of 5.5-7.9 dB together with 3 dB passbands of 89-102 MHz. The majority of the insertion loss can be attributed to the attenuation on free surface and inside the grating, and to the resistivity of the electrodes.     

Automatic particle detection through efficient Hough transforms

Manual selection of single particles in images acquired using cryo-electron microscopy (cryoEM) will become a significant bottleneck when a very large number of images are required to achieve three-dimensional reconstructions at near atomic resolution. Investigation of fast, accurate approaches for automatic particle detection has become one of the current challenges in the cryoEM community. At the same time, the investigation is hampered by the fact that few benchmark particles or image datasets exist in the community. The unavailability of such data makes it difficult to evaluate newly developed algorithms and to leverage expertise from other disciplines. The paper presents our recent contribution to this effort. It also describes our newly developed computational framework for particle detection, through the application of edge detection and a sequence of ordered Hough transforms. Experimental results using keyhole limpet hemocyanin (KLH) as a model particle are very promising. In addition, it introduces a newly established web site, designed to support the investigation of automatic particle detection by providing an annotated image dataset of KLH available to the general scientific community.     

A simple quenching method for fluorescence background reduction and its application to the direct, quantitative detection of specific mRNA

New genome sequence information is rapidly increasing the number of nucleic acid (NA) targets of use for characterizing and treating diseases. Detection of these targets by fluorescence-based assays is often limited by fluorescence background from unincorporated or unbound probes that are present in large excess over the target. To solve this problem, energy transfer-based probes have been developed and used to reduce the fluorescence from unbound probes. Although these probes have revolutionized NA target detection, their use requires scrupulous attention to design constraints, extensive probe quality control, and individually optimized experimental conditions. Here, we describe a simpler background reduction approach using singly labeled quencher oligomers to suppress excess unbound probe fluorescence following probe-target hybridization. A second limitation of most fluorescence-based NA target detection and quantification assays is the requirement for enzymatic amplification of target or signal for sensitivity. Amplification steps make quantification of original target copy number problematic because of variations in amplification efficiencies between the sequence targets and the experimental conditions. To avoid amplification, we coupled our quenching approach to a two-color NA assay with correlated, two-color, single-molecule fluorescence detection. We demonstrate a >100-fold background reduction and detection of targets present at concentrations as low as 100 fM using the two-color assay. The application of this technique to the detection and quantification of specific mRNA sequences enabled us to estimate beta-actin copy numbers in cell-derived total RNA without an amplification step.