Patient safety: latent risk factors van Beuzekom, M; Boer, F; Akerboom, S ...
British journal of anaesthesia : BJA,
07/2010, Letnik:
105, Številka:
1
Journal Article
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The person-centred analysis and prevention approach has long dominated proposals to improve patient safety in healthcare. In this approach, the focus is on the individual responsible for making an ...error. An alternative is the systems-centred approach, in which attention is paid to the organizational factors that create precursors for individual errors. This approach assumes that since humans are fallible, systems must be designed to prevent humans from making errors or to be tolerant to those errors. The questions raised by this approach might, for example, include asking why an individual had specific gaps in their knowledge, experience, or ability. The systems approach focuses on working conditions rather than on errors of individuals, as the likelihood of specific errors increases with unfavourable conditions. Since the factors that promote errors are not directly visible in the working environment, they are described as latent risk factors (LRFs). Safety failures in anaesthesia, in particular, and medicine, in general, result from multiple unfavourable LRFs, so we propose that effective interventions require that attention is paid to interactions between multiple factors and actors. Understanding how LRFs affect safety can enable us to design more effective control measures that will impact significantly on both individual performance and patient outcomes.
Patients’ perceptions on quality of care and gaps in diagnosis/management of rare endocrine diseases (RED) were collected in a 21-item questionnaire, answered on-line in the patients’ language. There ...were 598 (66% females) responses from 29 countries reflecting pituitary, adrenal, thyroid, parathyroid, gonadal, genetic and autoimmune diseases. While in 36% a diagnosis was made in <1 year, in 28% it took >5 years. In 64% it took 2–7 professionals for a correct diagnosis, after which in >50% a specialist/specific treatment was available within 1 month; 60% were satisfied with current treatment. Most (59–67%) would have liked access to psychological support, social worker, dietician or physiotherapist/rehabilitation specialists. Half were satisfied with information received, treatment and health care follow-up; 87% contacted patient/support groups; 78% agreed that “The personal limitations related to the disease, impact on my everyday quality of life”. Conclusion: Diagnostic delay in RED is still unsatisfactory in Europe, as well as specific needs impacting QoL.
Objective Given that volumes of patients and interventions are important criteria to qualify as a reference centre (RC) for the European Reference Network on Rare Endocrine Conditions (Endo-ERN), the ...present study aimed to evaluate the data that were reported in the original application against subsequent assessments of activity and review the criteria that may define RCs using two main thematic groups (MTGs): Pituitary and Thyroid, as examples. Methods Review of content in application forms and continuous monitoring data and of a survey distributed to RCs. A list of ‘key procedures’ for the assessment of performance of RCs was composed with the help of the Pituitary and Thyroid MTG chairs. Results In the original application, the number of undefined procedures ranged from 20 to 5500/year (Pituitary) and from 10 to 2700/year (phyroid) between applicants. In the survey, the number of key procedures per centre ranged from 18 to 150/year (Pituitary) and from 20 to 1376/year (Thyroid). The median numbers of new patients reported in the continuous monitoring program were comparable with the application and survey; however, some centres reported large variations. Conclusions Monitoring of clinical activity in an ERN requires clear definitions that are optimally aligned with clinical practice, diagnosis registration, and hospital IT systems. This is a particular challenge in the rare disease field where the centre may also provide expert input in collaboration with local hospitals. Application of uniform definitions, in addition to condition-specific clinical benchmarks, which can include patient-reported- as well as clinician-reported outcome measures, is urgently needed to allow benchmarking of care across Endo-ERN.
This manuscript describes the optimization of the front-end readout electronics for high granularity hybrid pixel detectors. The theoretical study aims at minimizing the noise and jitter. The model ...presented here is validated with both circuit post layout simulations and measurements on the Timepix4 Application Specific Integrated Circuit (ASIC). The analog front-end circuit and the procedure to optimize the dimensions of the main transistors are described with detail.
The Timepix4 is the most recent ASIC designed in the framework of the Medipix4 Collaboration. It was manufactured in 65nm CMOS process, and consists of a four side buttable matrix of 448 × 512 pixels with 55µm pitch. The analog front-end has a gain of ∼36mV/ke- when configured in High Gain Mode, and ∼20mV/ke- when configured in Low Gain Mode. The Equivalent Noise Charge (ENC) is ∼68e-rms and ∼80e-rms in High Gain Mode and in Low Gain Mode respectively. In event driven mode the incoming hits can be time stamped within a ∼ 200ps time bin and the chip can deal with a maximum flux of ∼ 3.6MHzmm−2s−1. In photon counting mode, the chip can deal with up to ∼ 5GHzmm−2s−1.
The routine designed to optimize the Timepix4 front-end is then used to analyze the performance limits in terms of jitter and noise for Charge Sensitive Amplifiers in pixel detectors.
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