Reducing Culture Reporting Errors in the Microbiology Laboratory

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S131-S132
Author(s):  
Kathryn Hogan ◽  
Beena Umar ◽  
Mohamed Alhamar ◽  
Kathleen Callahan ◽  
Linoj Samuel
Keyword(s):  
Real Time ◽  
Error Rate ◽  
Reporting System ◽  
Error Rates ◽  
Tracking Errors ◽  
Corrective Measures ◽  
Safety Awareness ◽  
Before And After ◽  
Set Up ◽  
System Errors

Abstract Objectives There are few papers that characterize types of errors in microbiology laboratories and scant research demonstrating the effects of interventions on microbiology lab errors. This study aims to categorize types of culture reporting errors found in microbiology labs and to document the error rates before and after interventions designed to reduce errors and improve overall laboratory quality. Methods To improve documentation of error incidence, a self-reporting system was changed to an automatic reporting system. Errors were categorized into five types Gram stain (misinterpretations), identification (incorrect analysis), set up labeling (incorrect patient labels), procedures (not followed), and miscellaneous. Error rates were tracked according to technologist, and technologists were given real-time feedback by a manager. Error rates were also monitored in the daily quality meeting and frequently detected errors were discussed at staff meetings. Technologists attended a year-end review with a manager to improve their performance. To maintain these changes, policies were developed to monitor technologist error rate and to define corrective measures. If a certain number of errors per month was reached, technologists were required to undergo retraining by a manager. If a technologist failed to correct any error according to protocol, they were also potentially subject to corrective measures. Results In 2013, we recorded 0.5 errors per 1,000 tests. By 2018, we recorded only 0.1 errors per 1,000 tests, an 80% decrease. The yearly culture volume from 2013 to 2018 increased by 32%, while the yearly error rate went from 0.05% per year to 0.01% per year, a statistically significant decrease (P = .0007). Conclusion This study supports the effectiveness of the changes implemented to decrease errors in culture reporting. By tracking errors in real time and using a standardized process that involved timely follow-up, technologists were educated on error prevention. This practice increased safety awareness in our micro lab.

P30 The effects of introducing electronic prescribing for paediatric chemotherapy using aria on prescribing error rates at a primary treatment centre

2018 ◽  
Vol 103 (2) ◽  
pp. e2.33-e2
Author(s):  
Peter Cook ◽  
Andy Fox
Keyword(s):  
Acute Lymphoblastic Leukaemia ◽  
Error Rate ◽  
Lymphoblastic Leukaemia ◽  
Error Rates ◽  
Electronic Prescribing ◽  
Patient Specific ◽  
Prescribing Errors ◽  
Prescribing Error ◽  
Error Type ◽  
Before And After

IntroductionPrescribing of medication in children is a very complex process that involves an understanding of paediatric physiology, disease states, medication used and pharmacokinetics as well as patient specific details, their co-morbidities and their clinical condition. The most common medication errors have been identified as dosing, route of administration, and frequency of administration. Computerised provider order entry has been shown to reduce the number of prescribing errors related to chemotherapy as well as the likelihood of dose and calculation errors in paediatric chemotherapy prescribing. Locally, paediatric chemotherapy is prescribed on pre-printed paper prescriptions. Adaptation and implementation of ARIA electronic prescribing (EP) system for use in paediatric chemotherapy was undertaken by a Specialist Paediatric Oncology Pharmacist and was rolled out for use in January 2016 for patients with acute lymphoblastic leukaemia.MethodThe United Kingdom National Randomised Trial for Children and Young Adults with Acute Lymphoblastic Leukaemia and Lymphoma 2011 (UKALL, 2011) was developed for use on EP, with prescribing of all other chemotherapy remaining on paper. The number and type of prescribing errors were collected during a pre-implementation phase from January 2015 to June 2015. After the introduction of EP and following a 2 month acclimatisation period, a second period of data collection took place between March 2016 and July 2016. Overall prescribing error rates and the frequency of each error type were calculated both before and after implementation.ResultsBefore the introduction of EP for paediatric chemotherapy, the overall error rate was 18.4% with a total of 16 different errors seen. Post implementation, overall error rate increased to 25.7% (p<0.001) with a total of 10 different errors seen. After introduction of EP, prescribing error rates on paper were 30.6% and on EP were 7.0% (p<0.001). Only 5 different error types were seen with electronic prescribing. The most commonly seen errors in prescribing with paper, both before and after were almost eliminated with the introduction of EP.ConclusionThe introduction of EP has resulted in a significant reduction in prescribing error rates compared to paper based prescribing for paediatric chemotherapy. Overall the prescribing error rate increased after the introduction of EP but this was related to an increased rate on the paper prescriptions. One possible reason for this was the use of dual systems for prescribing. In addition there was unforeseen relocation and building work within the paediatric cancer unit, which affected prescribing time allocation. There were also several staff shortages within the prescribing team after implementation and this resulted in an increased workload on the remaining chemotherapy prescribers. All these issues could have attributed to the increase in error rates. The most common errors seen with chemotherapy prescribing have been reduced with EP as protocols have been developed with a focus on prescribing safety. Further work is needed as more prescribing takes place on EP to assess the full impact it has on paediatric chemotherapy error rates.

Evaluation of Freezing Methods by Low Temperature X-Ray Diffraction

1977 ◽  
Vol 35 ◽  
pp. 330-333
Author(s):  
T. Gulik-Krzywicki ◽  
M.J. Costello
Keyword(s):  
Biological Materials ◽  
Molecular Organization ◽  
X Ray Diffraction ◽  
Glass Capillary ◽  
X Ray ◽  
Rate Dependent ◽  
Before And After ◽  
Freeze Etching ◽  
Diffraction Patterns ◽  
Set Up

Freeze-etching electron microscopy is currently one of the best methods for studying molecular organization of biological materials. Its application, however, is still limited by our imprecise knowledge about the perturbations of the original organization which may occur during quenching and fracturing of the samples and during the replication of fractured surfaces. Although it is well known that the preservation of the molecular organization of biological materials is critically dependent on the rate of freezing of the samples, little information is presently available concerning the nature and the extent of freezing-rate dependent perturbations of the original organizations. In order to obtain this information, we have developed a method based on the comparison of x-ray diffraction patterns of samples before and after freezing, prior to fracturing and replication.Our experimental set-up is shown in Fig. 1. The sample to be quenched is placed on its holder which is then mounted on a small metal holder (O) fixed on a glass capillary (p), whose position is controlled by a micromanipulator.

Perceptual Characteristics of Consonant Production in Apraxia of Speech and Aphasia

2019 ◽  
Vol 28 (4) ◽  
pp. 1411-1431 ◽  
Author(s):  
Lauren Bislick ◽  
William D. Hula
Keyword(s):  
Error Rate ◽  
Error Rates ◽  
Group Differences ◽  
Diagnostic Process ◽  
Apraxia Of Speech ◽  
Contextual Variables ◽  
Error Type ◽  
Type Distribution ◽  
Phonetic Features ◽  
Syllable Position

Purpose This retrospective analysis examined group differences in error rate across 4 contextual variables (clusters vs. singletons, syllable position, number of syllables, and articulatory phonetic features) in adults with apraxia of speech (AOS) and adults with aphasia only. Group differences in the distribution of error type across contextual variables were also examined. Method Ten individuals with acquired AOS and aphasia and 11 individuals with aphasia participated in this study. In the context of a 2-group experimental design, the influence of 4 contextual variables on error rate and error type distribution was examined via repetition of 29 multisyllabic words. Error rates were analyzed using Bayesian methods, whereas distribution of error type was examined via descriptive statistics. Results There were 4 findings of robust differences between the 2 groups. These differences were found for syllable position, number of syllables, manner of articulation, and voicing. Group differences were less robust for clusters versus singletons and place of articulation. Results of error type distribution show a high proportion of distortion and substitution errors in speakers with AOS and a high proportion of substitution and omission errors in speakers with aphasia. Conclusion Findings add to the continued effort to improve the understanding and assessment of AOS and aphasia. Several contextual variables more consistently influenced breakdown in participants with AOS compared to participants with aphasia and should be considered during the diagnostic process. Supplemental Material https://doi.org/10.23641/asha.9701690

DEVELOPMENT OF MULTIPLEX REAL-TIME PCR ASSAY FOR SIX PATHOGENS: RAPID TOOL FOR DIAGNOSIS OF BACTERIAL MENINGITIS

2019 ◽  
pp. 60-66
Author(s):  
Viet Quynh Tram Ngo ◽  
Thi Ti Na Nguyen ◽  
Hoang Bach Nguyen ◽  
Thi Tuyet Ngoc Tran ◽  
Thi Nam Lien Nguyen ◽  
...  
Keyword(s):  
Bacterial Meningitis ◽  
Real Time ◽  
Real Time Pcr ◽  
Diagnostic Methods ◽  
Type B ◽  
E Coli ◽  
Pcr Assays ◽  
Set Up ◽  
Etiological Agents ◽  
Suis Serotype

Introduction: Bacterial meningitis is an acute central nervous infection with high mortality or permanent neurological sequelae if remained undiagnosed. However, traditional diagnostic methods for bacterial meningitis pose challenge in prompt and precise identification of causative agents. Aims: The present study will therefore aim to set up in-house PCR assays for diagnosis of six pathogens causing the disease including H. influenzae type b, S. pneumoniae, N. meningitidis, S. suis serotype 2, E. coli and S. aureus. Methods: inhouse PCR assays for detecting six above-mentioned bacteria were optimized after specific pairs of primers and probes collected from the reliable literature resources and then were performed for cerebrospinal fluid (CSF) samples from patients with suspected meningitis in Hue Hospitals. Results: The set of four PCR assays was developed including a multiplex real-time PCR for S. suis serotype 2, H. influenzae type b and N. meningitides; three monoplex real-time PCRs for E. coli, S. aureus and S. pneumoniae. Application of the in-house PCRs for 116 CSF samples, the results indicated that 48 (39.7%) cases were positive with S. suis serotype 2; one case was positive with H. influenzae type b; 4 cases were positive with E. coli; pneumococcal meningitis were 19 (16.4%) cases, meningitis with S. aureus and N. meningitidis were not observed in any CSF samples in this study. Conclusion: our in-house real-time PCR assays are rapid, sensitive and specific tools for routine diagnosis to detect six mentioned above meningitis etiological agents. Key words: Bacterial meningitis, etiological agents, multiplex real-time PCR

Correction: “Influence of Selection Bias on the Test Decision – A Simulation Study”

2014 ◽  
Vol 53 (05) ◽  
pp. 343-343
Keyword(s):  
Selection Bias ◽  
Simulation Study ◽  
Error Rate ◽  
Type I Error ◽  
Block Size ◽  
Error Rates ◽  
Type I ◽  
Type I Error Rate ◽  
Representation Error ◽  
Numeric Representation

We have to report marginal changes in the empirical type I error rates for the cut-offs 2/3 and 4/7 of Table 4, Table 5 and Table 6 of the paper “Influence of Selection Bias on the Test Decision – A Simulation Study” by M. Tamm, E. Cramer, L. N. Kennes, N. Heussen (Methods Inf Med 2012; 51: 138 –143). In a small number of cases the kind of representation of numeric values in SAS has resulted in wrong categorization due to a numeric representation error of differences. We corrected the simulation by using the round function of SAS in the calculation process with the same seeds as before. For Table 4 the value for the cut-off 2/3 changes from 0.180323 to 0.153494. For Table 5 the value for the cut-off 4/7 changes from 0.144729 to 0.139626 and the value for the cut-off 2/3 changes from 0.114885 to 0.101773. For Table 6 the value for the cut-off 4/7 changes from 0.125528 to 0.122144 and the value for the cut-off 2/3 changes from 0.099488 to 0.090828. The sentence on p. 141 “E.g. for block size 4 and q = 2/3 the type I error rate is 18% (Table 4).” has to be replaced by “E.g. for block size 4 and q = 2/3 the type I error rate is 15.3% (Table 4).”. There were only minor changes smaller than 0.03. These changes do not affect the interpretation of the results or our recommendations.

Risk Prevention Measures for Three-Tower and Four-Span Suspension Bridge under Vehicle Fire

2014 ◽  
Vol 919-921 ◽  
pp. 590-597
Author(s):  
Mu Yu Liu ◽  
Wei Tian ◽  
Ying Wang ◽  
Wu Jing ◽  
Xi Chen
Keyword(s):  
Reporting System ◽  
Suspension Bridge ◽  
Risk Prevention ◽  
Public Security ◽  
Alarm System ◽  
Prevention Measures ◽  
Fire Control ◽  
Emergency Rescue ◽  
Report System ◽  
Set Up

Risk prevention measures were put forward about vehicle burning in operating periods for three-tower and four-span suspension bridge, combining with the characteristics of bridge vehicle burning accident. The article set up a traffic reporting system of the tankers for a bridge, and determined the report system of tankers across the bridge. Tankers should passed in the middle of the lane near the median under the guidance of bridge manager. Significant indicators were set on both ends of the bridge, so that vehicles could shunt rapidly in extreme fire conditions. Department of public security, fire control, transportation, bridges management center should get together to establish accident emergency rescue leading group, and formulated the security system of fire resistance and rescue organization for YingWuzhou Yangtze river bridge. Video monitoring alarm system and fire control facilities were set up in side pier, side tower, middle of the main span and the middle tower, which provided reliable and prevention measures for bridge operation.

scholarly journals Influence of extracorporeal membrane oxygenation on serum microRNA expression

2019 ◽  
Vol 47 (12) ◽  
pp. 6109-6119
Author(s):  
M. Scettri ◽  
H. Seeba ◽  
D. L. Staudacher ◽  
S. Robinson ◽  
D. Stallmann ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Real Time ◽  
Underlying Disease ◽  
Real Time Quantitative Pcr ◽  
Membrane Oxygenation ◽  
Serum Microrna ◽  
Clinical Biomarkers ◽  
Differentially Expressed Mirnas ◽  
Before And After ◽  
Medical Intensive Care

Objective To date, no biomarkers have been established to predict haematological complications and outcomes of extracorporeal membrane oxygenation (ECMO). The aim of this study was to investigate the expression of a panel of microRNAs (miRNAs), which are promising biomarkers in many clinical fields, in patients before and after initiating ECMO. Methods Serum miRNA levels from 14 patients hospitalized for acute respiratory failure and supported with ECMO in our medical intensive care unit were analysed before and 24 hours after ECMO. In total, 179 serum-enriched miRNAs were profiled by using a real-time PCR panel. For validation, differentially expressed miRNAs were individually quantified with conventional real-time quantitative PCR at 0, 24, and 72 hours. Results Under ECMO support, platelet count significantly decreased by 65 × 103/µL (25th percentile = 154.3 × 103/µL; 75th percentile = 33 × 103/µL). Expression of the 179 miRNAs investigated in this study did not change significantly throughout the observational period. Conclusions According to our data, the expression of serum miRNAs was not altered by ECMO therapy itself. We conclude that ECMO does not limit the application of miRNAs as specific clinical biomarkers for the patients’ underlying disease.

scholarly journals Assurance monitoring of learning-enabled cyber-physical systems using inductive conformal prediction based on distance learning

2021 ◽  
Vol 35 (2) ◽  
pp. 251-264
Author(s):  
Dimitrios Boursinos ◽  
Xenofon Koutsoukos
Keyword(s):  
Neural Networks ◽  
Distance Learning ◽  
Real Time ◽  
Speaker Recognition ◽  
Deep Neural Networks ◽  
Cyber Physical Systems ◽  
Error Rates ◽  
Traffic Sign ◽  
Conformal Prediction ◽  
Physical Systems

AbstractMachine learning components such as deep neural networks are used extensively in cyber-physical systems (CPS). However, such components may introduce new types of hazards that can have disastrous consequences and need to be addressed for engineering trustworthy systems. Although deep neural networks offer advanced capabilities, they must be complemented by engineering methods and practices that allow effective integration in CPS. In this paper, we proposed an approach for assurance monitoring of learning-enabled CPS based on the conformal prediction framework. In order to allow real-time assurance monitoring, the approach employs distance learning to transform high-dimensional inputs into lower size embedding representations. By leveraging conformal prediction, the approach provides well-calibrated confidence and ensures a bounded small error rate while limiting the number of inputs for which an accurate prediction cannot be made. We demonstrate the approach using three datasets of mobile robot following a wall, speaker recognition, and traffic sign recognition. The experimental results demonstrate that the error rates are well-calibrated while the number of alarms is very small. Furthermore, the method is computationally efficient and allows real-time assurance monitoring of CPS.

scholarly journals How effective are electronic medication systems in reducing medication error rates and associated harm among hospital inpatients? A systematic review and meta-analysis

2020 ◽  
Author(s):  
Peter J Gates ◽  
Rae-Anne Hardie ◽  
Magdalena Z Raban ◽  
Ling Li ◽  
Johanna I Westbrook
Keyword(s):  
Systematic Review ◽  
Medication Error ◽  
Medication Errors ◽  
Meta Analysis ◽  
Error Rates ◽  
Prescribing Error ◽  
Before And After ◽  
Actual Harm ◽  
Computer Based ◽  
Wide Scale

Abstract Objective To conduct a systematic review and meta-analysis to assess: 1) changes in medication error rates and associated patient harm following electronic medication system (EMS) implementation; and 2) evidence of system-related medication errors facilitated by the use of an EMS. Materials and Methods We searched Medline, Scopus, Embase, and CINAHL for studies published between January 2005 and March 2019, comparing medication errors rates with or without assessments of related harm (actual or potential) before and after EMS implementation. EMS was defined as a computer-based system enabling the prescribing, supply, and/or administration of medicines. Study quality was assessed. Results There was substantial heterogeneity in outcomes of the 18 included studies. Only 2 were strong quality. Meta-analysis of 5 studies reporting change in actual harm post-EMS showed no reduced risk (RR: 1.22, 95% CI: 0.18–8.38, P = .8) and meta-analysis of 3 studies reporting change in administration errors found a significant reduction in error rates (RR: 0.77, 95% CI: 0.72–0.83, P = .004). Of 10 studies of prescribing error rates, 9 reported a reduction but variable denominators precluded meta-analysis. Twelve studies provided specific examples of system-related medication errors; 5 quantified their occurrence. Discussion and Conclusion Despite the wide-scale adoption of EMS in hospitals around the world, the quality of evidence about their effectiveness in medication error and associated harm reduction is variable. Some confidence can be placed in the ability of systems to reduce prescribing error rates. However, much is still unknown about mechanisms which may be most effective in improving medication safety and design features which facilitate new error risks.

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