Application of Human Reliability Analysis to Nursing Errors in Hospitals

Adverse events in hospitals, such as in surgery, anesthesia, radiology, intensive care, internal medicine, and pharmacy, are of worldwide concern and it is important, therefore, to learn from such incidents. There are currently no appropriate tools based on state-of-the art models available for the analysis of large bodies of medical incident reports. In this study, a new model was developed to facilitate medical error analysis in combination with quantitative risk assessment. This model enables detection of the organizational factors that underlie medical errors, and the expedition of decision making in terms of necessary action. Furthermore, it determines medical tasks as module practices and uses a unique coding system to describe incidents. This coding system has seven vectors for error classification: patient category, working shift, module practice, linkage chain (error type, direct threat, and indirect threat), medication, severity, and potential hazard. Such mathematical formulation permitted us to derive two parameters: error rates for module practices and weights for the aforementioned seven elements. The error rate of each module practice was calculated by dividing the annual number of incident reports of each module practice by the annual number of the corresponding module practice. The weight of a given element was calculated by the summation of incident report error rates for an element of interest. This model was applied specifically to nursing practices in six hospitals over a year; 5,339 incident reports with a total of 63,294,144 module practices conducted were analyzed. Quality assurance (QA) of our model was introduced by checking the records of quantities of practices and reproducibility of analysis of medical incident reports. For both items, QA guaranteed legitimacy of our model. Error rates for all module practices were approximately of the order 10(-4) in all hospitals. Three major organizational factors were found to underlie medical errors: "violation of rules" with a weight of 826 x 10(-4), "failure of labor management" with a weight of 661 x 10(-4), and "defects in the standardization of nursing practices" with a weight of 495 x 10(-4).     

A Monte Carlo comparison of Jarque–Bera type tests and Henze–Zirkler test of multivariate normality

In the paper, tests for multivariate normality (MVN) of Jarque-Bera type, based on skewness and kurtosis, have been considered. Tests proposed by Mardia and Srivastava, and the combined tests based on skewness and kurtosis defined by Jarque and Bera have been taken into account. In the Monte Carlo simulations, for each combination of p = 2, 3, 4, 5 number of traits and n = 10(5)50(10)100 sample sizes 10,000 runs have been done to calculate empirical Type I errors of tests under consideration, and empirical power against different alternative distributions. Simulation results have been compared to the Henze–Zirkler’s test. It should be stressed that no test yet proposed is uniformly better than all the others in every combination of conditions examined.     

Effects of Customized Balance Exercises on Older Women Whose Balance Ability Has Deteriorated With Age

Falls represent a major public health problem for older adults, and loss of balance (LOS) abilities is one of the primary causes of falls. Previous studies have shown that balance training is effective in improving physical function and decreasing risk of falls. However, little attention has been given specifically to balance training in older adults with very poor balance. The purpose of this study was to determine the effect of a 12-week customized balance exercise program on LOS for community-dwelling older women with poor balance ability. Twenty-four older women with poor balance (composite maximum excursion [MXEcomp] score of less than 70% based on Limits of Stability) were divided into an exercise group and control group. After 12 weeks of balance exercises, mean MXEcomp improved (p < .05) from 58.6% to 79.0% in the exercise group. EPEcomp (composite endpoint excursion), RTcomp (composite reaction time), SVcomp3 (composite sway velocity on thick foam with the eyes open), UG (up and go) also improved, but the functional reach and other static balance indexes did not change. These results indicated that balance training allows older adults with poor balance to improve dynamic balance ability and potentially reduce risk for falls.     

Records of rat control campaigns in a food market with the largest seafood trading volume worldwide

Urban Ecosystems - Brown rats (Rattus norvegicus) and roof rats (Rattus rattus) are among the most common mammals worldwide. Little is known about the effects of season on rat population size,...     

Comparison of multiple behavioral traits between urban and rural squirrels

Urban Ecosystems - Recent rapid urbanization has imposed novel challenges to animals. Urban animals alter their behaviors such as increased boldness, exploration, and aggressiveness to cope with...