scholarly journals High reliability organisations and collective mindfulness for improving healthcare safety management: a scoping review protocol of factors, measures and instruments

2019 ◽  
Vol 3 (2) ◽  
pp. 8-13
Author(s):  
Manikam Pillay ◽  
Andrew Enya ◽  
Emmanuel Bannor Boateng
Keyword(s):  
Safety Management ◽  
High Reliability ◽  
Care Patient ◽  
Observer Agreement ◽  
Limited Attention ◽  
Double Blind ◽  
Collective Mindfulness ◽  
High Reliability Theory ◽  
Advance Research ◽  
Meta Analyses

A growing body of peer-reviewed studies demonstrate the importance of high-reliability organisations and collective mindfulness in improving healthcare safety. However, limited attention has been devoted to developing a common set of characteristics, dimensions, indicators and instruments for measuring collective mindfulness. This can limit its operationalisation and ability to benchmark. This protocol outlines the key procedures that will be used to conduct a scoping literature review, in order to summarise key definitions; identify theoretical underpinnings, dimensions, measures and instruments; and develop a theoretical model to advance research and practice. Specifically, a five-step process and the Preferred Reporting Instruments for Systematic and Meta-Analyses will be used to search, screen and select literature published in five electronic databases. Keywords will include a combination of ‘high-reliability organisations’, high-reliability theory’ with ‘health care’, ‘patient safety’, ‘medical errors’, ‘medical mistakes’, ‘medication error’. A double-blind process will be used for searching, screening and selection of abstracts and full-articles, and inter-observer agreement assessed using Cohen’s kappa.

FEMORAL NECK FRACTURES AND CLASSIFICATIONS RELIABILITY: ARE WE USING REPRODUCIBLE SYSTEMS?

2021 ◽  
pp. 2150015
Author(s):  
Emilio Enrietti ◽  
Marco Bechis ◽  
Giulia Nicolaci ◽  
Domenico Messina ◽  
Michele Reboli ◽  
...  
Keyword(s):  
Femoral Neck ◽  
High Reliability ◽  
Femoral Neck Fractures ◽  
Classification Systems ◽  
Observer Agreement ◽  
Type I ◽  
X Rays ◽  
Correct Treatment ◽  
Femur Fractures ◽  
Pauwels Classification

Introduction: Classification systems for femoral neck fractures are very helpful for surgeons in order to choose the correct treatment. The purpose of this study was to verify the reliability and reproducibility in the most used classifications for proximal medial femoral fracture: Garden and Pauwels classifications. Materials and methods: Five surgeons independently classified 82 intra-capsular femur fractures treated with 3 cannulated screws using Pauwels and Garden classifications measured on pre- and post-operatively X-Rays. Inter-observer agreement was calculated for both classifications using the multi-rater Fleiss’ kappa; intra-observer agreement from pre-operative to post-operative XRs for Pauwels classification was also calculated with the same method. Results: Only six cases of AVN were registered. The inter-observers agreement based on pre-operative X-rays was moderate for Pauwels classification ([Formula: see text] 0.528) and slightly lower for Garden classification ([Formula: see text] 0.448); but in the simplified Garden classification (type I and II not displaced vs type III and IV displaced) the agreement measured was almost perfect ([Formula: see text] 0.908). The intra-observer agreement for Pauwels classification was moderate ([Formula: see text] 0.456). All the results were statistically significant. Conclusions: This is the first study evaluating the Pauwels angle on both preoperative and postoperative X-rays to assess their reproducibility. Garden classification has a really high reliability and reproducibility in evaluating displaced and not displaced fractures and consequently can be helpful in choosing the correct treatment. Pauwels classification has a lower inter and intra-observer agreement.

scholarly journals Measuring the “Why” of Interaction: Development and Validation of the User Motivation Inventory (UMI)

2018 ◽  
Author(s):  
Florian Brühlmann ◽  
Beat Vollenwyder ◽  
Klaus Opwis ◽  
Elisa D Mekler
Keyword(s):  
Discriminant Validity ◽  
High Reliability ◽  
Need Satisfaction ◽  
Interactive System ◽  
Limited Attention ◽  
Total N ◽  
Convergent And Discriminant Validity ◽  
Core Concepts ◽  
Development And Validation ◽  
User Motivation

Motivation is a fundamental concept in understanding people’s experiences and behavior. Yet, motivation to engage with an interactive system has received only limited attention in HCI. We report the development and validation of the User Motivation Inventory (UMI). The UMI is an 18-item multidimensional measure of motivation, rooted in self-determination theory (SDT). It is designed to measure intrinsic motivation, integrated, identified, introjected, and external regulation, as well as amotivation. Results of two studies (total N = 941) confirm the six-factor structure of the UMI with high reliability, as well as convergent and discriminant validity of each subscale. Relationships with core concepts such as need satisfaction, vitality, and usability were studied. Additionally, the UMI was found to detect differences in motivation for people who consider abandoning a technology compared to those who do not question their use. The central role of motivation in users’ behavior and experience is discussed.

Reducing Latent Failure and Securing Productivity in High Risk Systems Using High Reliability Theory

2014 ◽  
Author(s):  
J.. Wattie
Keyword(s):  
Problem Solving ◽  
High Risk ◽  
High Reliability ◽  
Academic Research ◽  
Positive Influence ◽  
Reliability Theory ◽  
Constructive Method ◽  
Individual Interviews ◽  
High Reliability Theory ◽  
Ethnographic Methodology

Abstract This is a study that represents ongoing academic research into the folds of perception, organizational culture and high reliability. In the shadow of persistent industrial failures it is probable that problems with operational safety reside in abnormalities of culture. Such cultural apparitions regularly fuel failure in high risk technologies making innovation rather unreliable. As innovation grows it is worth the effort to investigate further how resilience in the face of eternal socio-technical biases can be improved. Problem solving approaches offer regressive ideas that increase the chances of deviation and the appearace of disasters. The assumption is that resilience can be improved in critical operations using High Reliability Theory (HRT). Moreover HRT is more robust when the new constructive method of Appreciative Inquiry (AI) is applied. This early study shows that existing safety culture in a highly reliable group is positively transformed by AI and makes a more productive organization feasible. Research was conducted from the characteristic insider perspective. A small section of a highly reliable organization was sampled. Using ethnographic methodology feedback from electronic surveying collected personal responses for discussion. While individual interviews proved difficult and the sample group was small there was enough evidence to acknowledge the influence of positive revolution. This study had two major findings a) Using AI methodology stimulates positive, resilient feelings in members and b) members readily used these positive experience to envision a more productive organization. This study can potentially reduce over emphasis on problem solving methods to explain and change the human factors associated with failure. Cultural factors are better studied and modified by positive influence. The study here makes way for more persuasive academic discussion on resilience by constructivist perspectives. High reliability organizations are more sustainably designed on positive principles.

scholarly journals Sodium Nitroprusside Infusion for the Treatment of Schizophrenia

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Mark Weiser ◽  
Daisy Zamora ◽  
Linda Levi ◽  
Valentin Matei ◽  
Ilan Gonen ◽  
...  
Keyword(s):  
Sodium Nitroprusside ◽  
Wide Spectrum ◽  
Controlled Trial ◽  
Study Groups ◽  
Current Evidence ◽  
Double Blind ◽  
Syndrome Scale ◽  
Meta Analyses ◽  
A Site ◽  
Negative Syndrome

Abstract One previous small single-center clinical trial showed that a single intravenous administration of sodium nitroprusside added-on to antipsychotics improved a wide spectrum of schizophrenia (SCZ) symptoms more than placebo, and the improvement persisted for 4 weeks after infusion even though no additional drug was given. Our study attempted to replicate these data in a 4-week, add-on, double-blind, randomized, placebo-controlled trial on 20 patients performed in a site in Romania and a site in Moldova. This study’s sample size and protocol were identical to the previous trial, including patients with a diagnosis of SCZ, within the first 5 years after diagnosis. Patients recruited needed to have a baseline total positive and negative syndrome scale (PANSS) score of 60 or above. Ten participants received a single dose of 0.5 µg/kg/min intravenous sodium nitroprusside over 4 hours, and 10 participants received matching placebo infusion, added-on to antipsychotics. The primary outcomes were the PANSS total score and the PANSS negative subscale. There were no significant between-group differences in PANSS total scores or negative subscale scores during the infusion on daily evaluations for the next 7 days nor on weekly evaluations at weeks 2, 3, and 4. No significant differences were found between the 2 study groups in adverse events. Meta-analyses including all 5 published randomized controlled trials on the topic, representing 155 subjects, do not show a statistically significant benefit of sodium nitroprusside. We conclude that the current evidence does not support the efficacy of sodium nitroprusside in the treatment of SCZ.

Changing Perspectives of Stress Gastritis Prophylaxis

1994 ◽  
Vol 28 (9) ◽  
pp. 1073-1085 ◽  
Author(s):  
Maureen A. Smythe ◽  
Barbara J. Zarowitz
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Data Extraction ◽  
Care Patient ◽  
Receptor Antagonists ◽  
Data Synthesis ◽  
Medline Search ◽  
Prophylactic Agent ◽  
Study Selection ◽  
Meta Analyses

OBJECTIVE: To present recent advances in stress gastritis prophylaxis in the critically ill and review considerations in selection of a prophylactic agent. DATA SOURCES: Information was obtained from MEDLINE search, reference lists from articles identified in search, and from review articles. STUDY SELECTION: Emphasis was placed on controlled trials conducted within the last 5 years. DATA EXTRACTION: All literature was assessed for methodology, results, and conclusions. Results of prospective, randomized trials, and meta-analyses are summarized. DATA SYNTHESIS: Histamine2-receptor antagonists, antacids, and sucralfate appear equally effective in preventing stress gastritis in the critically ill. A definitive cause–effect relationship between histamine2-receptor antagonists and increased incidence of nosocomial pneumonia has not yet been established. The indications for using a prophylactic agent and consideration in selecting an agent should include an evaluation of the following: Risk factors for gastritis including the type of intensive care patient, comparative efficacy, adverse effects, drug interactions, cost, and ease of administration. The least expensive, safest agent requiring minimal monitoring is sucralfate. Prevention of stress gastritis has never been shown to reduce morbidity or mortality significantly. CONCLUSIONS: Controversies still exist regarding the need to provide prophylaxis, the choice of an agent, and the relative importance of previously identified risk factors. Further well-designed studies are needed before consensus can be reached.

Immediate versus wait-and-gradual discontinuation in antipsychotic switching: A meta-analysis

2020 ◽  
Vol 34 (8) ◽  
pp. 914-919
Author(s):  
Hiroyoshi Takeuchi ◽  
Gary Remington
Keyword(s):  
Clinical Outcomes ◽  
Meta Analysis ◽  
Outcome Data ◽  
Controlled Trials ◽  
Double Blind ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Meta Analyses ◽  
Switching Strategies

Introduction: In two previous meta-analyses of randomized controlled trials (RCTs) examining antipsychotic switching strategies in patients with schizophrenia, we showed no significant differences in any clinical outcomes between immediate versus gradual and gradual versus wait-and-gradual discontinuation of the pre-switch antipsychotic. In this report, we compared immediate versus wait-and-gradual antipsychotic discontinuation. Methods: We identified five RCTs examining immediate versus wait-and-gradual discontinuation of the pre-switch antipsychotic in antipsychotic switching involving patients with schizophrenia. However, no data were available from one RCT. The following clinical outcome data were extracted and meta-analyzed: study discontinuation, psychopathology, extrapyramidal symptoms, and treatment-emergent adverse events that were reported in two or more of the studies. Results: The meta-analysis included four RCTs involving 351 patients ( n=175 for immediate and n=176 for wait-and-gradual antipsychotic discontinuation). A significant difference was found in study discontinuation due to all causes ( n=4, n=351, risk ratio=1.58, 95% confidence interval 1.15–2.17, p=0.005, I2=0%) between the immediate and wait-and-gradual antipsychotic discontinuation groups, while there was no significant difference in any other clinical outcomes. The group difference in study discontinuation due to all causes remained significant for the studies adopting immediate antipsychotic initiation but not for the studies switching to ziprasidone. Conclusion: Findings suggest that wait-and-gradual antipsychotic discontinuation may be preferable when a more cautious antipsychotic switch is needed. However, further long-term, double-blind RCTs are needed to confirm the present findings.

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