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.     

The computer-aided design of modular fixturing systems

The flexibility of modular fixturing systems can be exploited to significantly enhance the productivity of computer integrated manufacturing facilities. A major impediment to the implementation of this philosophy is the absence of viable methodologies for the automated design and assembly of these fixturing systems. This paper addresses this technological void by proposing a CAD/CAM tool for the automated design and robotic assembly of modular fixturing systems which can form the basis for a fully automated design system. The development of automated flexible fixturing technologies that transcend the traditional time-consuming and expensive practice of manual assembly would significantly contribute to the evolution to the factory-of-the-future.     

Solution properties of methyl methacrylate–acrylonitrile copolymers

Characterization of methyl methacrylate-acrylonitrile copolymers is done through viscosity, swelling, and differential refractometric studies. Viscosities of the copolymers and homopolymers were determined at 30, 40, and 50°C. The activation parameters of viscous flow, voluminosity, and shape factor were also calculated. The average shape factor was observed to be 2.5 ± 0.005 for all copolymer systems. Viscosity molecular weights were calculated, and from intramolecular expansion factor (α), it was observed that copolymers are less flexible than are homopolymers. dn/dc values obtained from differential refractometry are in good agreement with those calculated theoretically. © 1993 John Wiley & Sons, Inc.     

Patient safety and computerized medication ordering at Brigham and Women's Hospital

BACKGROUND: Medications are important therapeutic tools in health care, yet creating safe medication processes is challenging for many reasons. Computerized physician order entry (CPOE), one important way that technology can be used to improve the medication process, has been in place at Brigham and Women's Hospital (BWH; Boston) since 1993. CPOE AT BWH: The CPOE application, designed and developed internally by the BWH information systems team, allows physicians and other clinicians to enter all patient orders into the computer. Physicians enter 85% of orders, with the remainder entered electronically by other clinicians. CPOE AND SAFE MEDICATION USE: The CPOE application at BWH includes several features designed to improve medication safety--structural features (for example, required fields, use of pick lists), enhanced workflow features (order sets, standard scales for insulin and potassium), alerts and reminders (drug-drug and drug-allergy interaction checking), and adjunct features (the pharmacy system, access to online reference information). RESULTS AT BWH: Studies of the impact of CPOE on physician decision making and patient safety at BWH include assessment of CPOE's impact on the serious medication error and the preventable adverse drug event rate, the impact of computer guidelines on the use of vancomycin, the impact of guidelines on the use of heparin in patients at bed rest, and the impact of dosing suggestions on excessive dosing. CONCLUSION: CPOE and several forms of clinical decision support targeted at increasing patient safety have substantially decreased the frequency of serious medication errors and have had an even bigger impact on the overall medication error rate.     

Person tracking and reidentification: Introducing Panoramic Appearance Map (PAM) for feature representation

This paper develops a concept of Panoramic Appearance Map (PAM) for performing person reidentification in a multi-camera setup. Each person is tracked in multiple cameras and the position on the floor plan is determined using triangulation. Using the geometry of the cameras and the person location, a panoramic map centered at the person’s location is created with the horizontal axis representing the azimuth angle and vertical axis representing the height. Each pixel in the map image gets color information from the cameras which can observe it. The maps between different tracks are compared using a distance measure based on weighted SSD in order to select the best match. Temporalintegration by registering multiple maps over the tracking period improves the matching performance. Experimental results of matching persons between two camera sets show the effectiveness of the approach. This work has been sponsored by the Technical Support Working Group (TSWG) of US Department of Defence (DoD).     

An ensemble-based incremental learning approach to data fusion.

This paper introduces Learn++, an ensemble of classifiers based algorithm originally developed for incremental learning, and now adapted for information/data fusion applications. Recognizing the conceptual similarity between incremental learning and data fusion, Learn++ follows an alternative approach to data fusion, i.e., sequentially generating an ensemble of classifiers that specifically seek the most discriminating information from each data set. It was observed that Learn++ based data fusion consistently outperforms a similarly configured ensemble classifier trained on any of the individual data sources across several applications. Furthermore, even if the classifiers trained on individual data sources are fine tuned for the given problem, Learn++ can still achieve a statistically significant improvement by combining them, if the additional data sets carry complementary information. The algorithm can also identify-albeit indirectly-those data sets that do not carry such additional information. Finally, it was shown that the algorithm can consecutively learn both the supplementary novel information coming from additional data of the same source, and the complementary information coming from new data sources without requiring access to any of the previously seen data.     

Effect of low-density filler on mechanical properties of syntactic foams of cyanate ester

Syntactic foam composites of cyanate ester with varying volume fractions of resin and glass microballoon were processed and evaluated for tensile, flexural and compressive properties. The effect of nature and volume fraction of microballoon on the mechanical properties was studied. The mechanical properties showed a gradual decrease in strength with increase in volume fraction of microballoon. The specific strength values also manifested a similar order. A similar behaviour was observed for syntactic foams with microballoons of varying true density. The properties increased proportional to the strength of the microballoon in resin-rich systems implying a strong microballoon-resin interface, corroborated by Scanning Electron Microscopy studies. The compressive modulus showed a decreasing trend with enhanced microballoon loading.     

Behavior of Stone Columns Based on Experimental and FEM Analysis

A detailed experimental study on behavior of single column and group of seven columns is carried out by varying parameters like spacing between the columns, shear strength of soft clay, and loading condition. Laboratory tests are carried out on a column of 100?mm diameter surrounded by soft clay of different consistency. The tests are carried out either with an entire equivalent area loaded to estimate the stiffness of improved ground or only a column loaded to estimate the limiting axial capacity. During the group experiments, the actual stress on column and clay were measured by fixing pressure cells in the loading plate. Finite-element analyses have also been performed using 15-noded triangular elements with the software package PLAXIS. A drained analysis was carried out using Mohr-Coulomb’s criterion for soft clay, stones, and sand. The numerical results from the FEM are compared with the experimental results which showed good agreement between the results. Columns arranged with spacings more than 3 times the diameter of the column does not give any significant improvement. Based on the results, design charts are developed and a design procedure is suggested.     

An improved algorithm for connectivity analysis of distribution networks

In the present paper, an efficient algorithm for connectivity analysis of moderately sized distribution networks has been suggested. Algorithm is based on generation of all possible minimal system cutsets. The algorithm is efficient as it identifies only the necessary and sufficient conditions of system failure conditions in n-out-of-n type of distribution networks. The proposed algorithm is demonstrated with the help of saturated and unsaturated distribution networks. The computational efficiency of the algorithm is justified by comparing the computational efforts with the previously suggested appended spanning tree (AST) algorithm. The proposed technique has the added advantage as it can be utilized for generation of system inequalities which is useful in reliability estimation of capacitated networks.