Search

The first orthodontic program was opened by Edward H. Angle in 1900 as the Angle School of Orthodontia. From 1900 to 2024, over 70 exceptional orthodontic programs have been developed to provide comprehensive orthodontic education to postdoctoral residents. During this time, numerous innovations have been introduced in orthodontics which have changed the clinical practice of orthodontics. Orthodontic programs need to incorporate such innovations into their curriculum so that the residents are knowledgeable of current developments. To incorporate innovations into orthodontic residency programs, it is important to balance it with standardization. Standardization can be explained in terms of roadmaps and checklists for different innovations. This article aims to provide roadmaps, checklists, and principles for incorporating and teaching innovation into the orthodontic residency curriculum. [ABSTRACT FROM AUTHOR]

The research aims to assess the quality of construction and construction projects in Egypt (Damanhour City) to monitor and follow up on the reality of the implementation of engineering projects and determine their percentage compared to the methods and international standards adopted for that and then identify the reasons and factors affecting the quality of project implementation. To achieve this, we evaluated the quality and identified the problems related to it in a sample of construction projects implemented in the year 2021, and this was done by measuring the percentage of conformity to quality requirements using checklists according to the standards of the quality management program BIM 360 field, and the conformity rate was 88% and indicates the existence of a real problem according to international standards, so problems and deviations related to quality were identified and the reasons leading to the occurrence of these problems were identified, which were classified into three factors, namely laws, regulations and compliance It has technical factors and administrative factors, which constitute the basis that must be based on it and try to improve the quality of projects, and summarized the research to the need to work by the concerned authorities to reformulate laws related to engineering work and develop them with the identification of systems and procedures to improve technical and administrative factors in engineering projects. [ABSTRACT FROM AUTHOR]

This study seeks to evaluate the technician in the Department of Sports and School Activity in the General Directorate of Education of Baghdad / Al-Rusafa II, according to the requirements of the standard of artificial intelligence techniques in order to diagnose and identify the gap between the technical performance of this section with the requirements of the standard, identify the causes of the gap and propose effective solutions for it. The checklist was used to collect data and information according to the scale of artificial intelligence technologies with five axes (expert systems, virtual reality, smart agents, information technologies, and process automation). The Department of Sports and School Activity in the General Directorate of Education of Baghdad / Al-Rusafa II (case study) have a clear perception of the importance of the measure of artificial intelligence techniques, but the absence of financial and technical capabilities prevents the adoption of this measure in the management of the department, in addition to the lack of management of the department of an administrative unit to follow up the functional work And technology and studying the causes of deviation and the procedures to be followed for the purpose of controlling all factors affecting artificial intelligence techniques, and by examining the results of this study obtained from the checklists, it can be indicated that there are weaknesses in all the requirements that must be available in the sports and school activity section and according to the requirements of the intelligence techniques scale With regard to the axis of expert systems and the axis of smart agents, the percentage of matching dolls was (0%) and the gap for non-conformity amounted to (1). As for the axis of virtual impact, it is not less important than them, as the amount of the gap amounted to (0.9), but the amount of the gap for the axes of information technology and process automation is (0.3), which indicates that the Department of Sports and School Activity applies in its work to most of the paragraphs of these two axes to the requirements of the scale of artificial intelligence technologies. [ABSTRACT FROM AUTHOR]

Closed circuit rebreathers have been widely adopted by technical divers as tools for reducing gas consumption and extending depth and duration capabilities. Rebreathers are technologically complex with many failure points, and their use appears associated with a higher accident rate than open circuit scuba. Rebreather Forum Four (RF4) was held in Malta in April 2023 attracting approximately 300 attendees and representatives of multiple manufacturers and training agencies. Over two and a half days a series of lectures was given by influential divers, engineers, researchers and educators on topics of contemporary relevance to rebreather diving safety. Each lecture was followed by a discussion session with audience participation. Potential consensus statements were drafted by the authors (SJM and NWP) during the course of the meeting. These were worded to be confluent with some important messages emerging from the presentations and subsequent discussions. The statements were presented one by one in a half-day plenary session of participants, and discussion was invited on each. After discussion and any necessary revision, the participants voted on whether to adopt the statement as a position of the forum. A clear majority was required for acceptance. Twenty-eight statements embracing thematic areas designated ‘safety’, ‘research’, ‘operational issues’, ‘education and training’, and ‘engineering’ were adopted. Those statements are presented along with contextualising narrative where necessary. The statements may help shape research and teaching initiatives, and research and development strategies over subsequent years. [ABSTRACT FROM AUTHOR]

The discipline of human factors and ergonomics is largely focused on principled development of generalizable solutions. The process is typically slow, spanning months, even years. A crisis such as the COVID-19 pandemic presents a different problem. How can human factors and ergonomics professionals react quickly, within hours or days, to provide viable solutions to unanticipated problems as they become apparent? Here we report on a small project in which we were able to respond rapidly to an emergent COVID-19 requirement. Given time constraints, we had no opportunity to follow a systematic analysis and design strategy. Our development and testing strategies reveal lessons that can be applied more generally to development of human factors and ergonomics interventions within emerging crises. [ABSTRACT FROM AUTHOR]

• Use of an official checklist correlated with higher variation within the center. • Workload was not correlated with variation in practice of physics plan review. • Inter-center practice variation increased with multi-vendor institutes. In this article we report on the results of a survey of physics plan review practices conducted by the Cancer Care Ontario Communities of Practice and the variations in practice between and within centers. The medical physicists at each center worked together to complete the survey and submit a single response for that center. A 4-point Likert scale, used to report the variation in practice at each center, was quantified into two parameters: "Intra-center variation", the distribution of responses within the center, and "Variation between centers", the difference between the center's response and the provincial mean. These metrics were correlated with center characteristics to identify factors that impacted on variations in practice. Bolus and heterogeneity correction were the only two items checked by all physicists in all centers. In more than half of the centers, image registration and DVH binning are not likely checked by physics. A significant difference in the variation between centers is observed for centers that used a single vendor's products. Centers that used an official checklist indicated higher levels and a wider range of Intra-center variation. Higher workload did not affect the variation in checking patterns between physicists in the same center. The effect of a center's resources on their checking practice suggest that local environment and workflow be accounted for when implementing TG275 guidelines. The observation that standardized checklists did not reduce checking variability point to the importance of following the checklist development guidelines in MPPG4 to avoid ineffective checklists. [ABSTRACT FROM AUTHOR]

There is controversy over certain aspects of post-appendectomy care for children with uncomplicated appendicitis. Some institutions have embraced the practice of same-day discharge after appendectomy, while others are hesitant due to concerns about increased readmissions or emergency department (ED) visits. Similarly, some surgeons have transitioned to treating gangrenous appendicitis with a single perioperative dose, while others are concerned about increased risk of infection in this population. We developed a pathway for the management of patients undergoing appendectomy for uncomplicated acute appendicitis which included same-day discharge and elimination of postoperative antibiotics for patients with gangrenous appendicitis. We compared outcomes for children treated at our institution before and after implementation of the protocol. We identified 575 patients undergoing appendectomy for uncomplicated appendicitis (307 pre- and 268 post-protocol). We observed a significant decrease in postoperative length-of stay (10.6 to 2.6 h, p < 0.0001). There were no increases in postoperative complications, such as superficial (2.6% vs 1.1%, p = 0.19) or organ-space surgical-site infection (1.6% vs 0.4%, p = 0.14), percutaneous drain placement (1.3% vs 0%, p = 0.06), postoperative ED visits (5.5% vs 5.2%, p = 0.87) or readmission (3.3% vs 1.5%, p = 0.17). These findings suggest that incorporating same-day discharge for simple appendicitis and eliminating postoperative antibiotics for children with gangrenous appendicitis does not increase complication rates. Implementation of similar pathways across institutions has the potential to significantly reduce resource utilization for children undergoing appendectomy for uncomplicated appendicitis. Retrospective comparative study. Level III. [ABSTRACT FROM AUTHOR]

Children requiring gastrostomy tubes (GT) have high resource utilization. In addition, wide variation exists in the decision to perform concurrent fundoplication, which can increase the morbidity of enteral access surgery. We implemented a hospital-wide standardized pathway for GT placement. The standardized pathway included mandatory preoperative nasogastric feeding tube (FT) trial, identification of FT medical home, and standardized postoperative order set, including feeding regimen and parent education. An algorithm to determine whether concurrent fundoplication was indicated was also created. We identified children referred for GT placement from 2015 to 2018 and compared concurrent fundoplication rates and outcomes pre- and postimplementation. We identified 332 patients who were referred for GT. Of these, 15 avoided placement. Concurrent fundoplication decreased postpathway (48% vs 22%, p < 0.0001). After adjusting for reflux and cardiac disease, prepathway patients were 3.5 times more likely to undergo concurrent fundoplication. ED visits (46% vs 27%, p = 0.001) and postoperative LOS (median (IQR) 10 days (5–36) to 5.5 days (1–19), p = 0.0002) decreased. A standardized pathway for GT placement prevented unnecessary GT placement and fundoplication with reduction in postoperative LOS and ED visits. This approach can significantly reduce resource utilization while improving outcomes. Prognosis study. Level II. [ABSTRACT FROM AUTHOR]

Abstract Checklists are memory aids comprised of various tasks to complete a process and have been successful in preventing errors and improving performance in various fields including aviation, aeronautics, and construction. (1) In recent years, use of safety checklists has increased within the medical field to standardize care and improve communication amongst providers and they hold significant promise to improve outcomes during obstetric emergencies. [ABSTRACT FROM AUTHOR]

Background: Neonatal nurse practitioner (NNP) procedural competence is essential. Procedural simulation provides opportunity to practice high-risk, low-frequency procedures and helps improve skill retention. A formal procedural simulation experience was created in an attempt to provide sufficient experience for NNPs. While preparing for the simulation experience, the group recognized the lack of validated competency metrics for most neonatal intensive care unit (NICU) procedures.Purpose: The purpose of this study was to create and validate procedural checklists measuring competence of NNPs participating in simulated performance of 9 high-risk NICU procedures.Methods: IRB approval was obtained and NNPs agreed to data collection. A self and peer assessment tool was developed and distributed to NNPs, nurses, and neonatologists to gather a baseline perception of procedural competency. Procedural checklists were then developed to measure/assess individual skills against a standard. Benchmark videos were created to demonstrate the standard approach to procedural performance. Each procedural skill performed by the NNP participant was scored by 3 individual evaluators: once in real time and twice by video recording analysis.Findings/results: A Cronbach α was used to measure the reliability and validity of the procedural checklists. Comparison was made between live grading and video-based grading scores using analysis of variance. Difference between grading modalities was less than 3% and nonsignificant for 8 of 9 procedures. No significant difference was found between individual graders for any of the skills being evaluated and suggested high interrater reliability of the checklists.Implications For Practice: Objective, standardized procedural checklists are valid tools to evaluate NNP procedural skills in simulation. Procedural simulation experiences help strengthen skills, improve performance, and possibly improve patient outcomes. [ABSTRACT FROM AUTHOR]

Thorough documentation is essential for hospital reimbursement from payors such as the Centers for Medicare & Medicaid Services. Inconsistencies and incomplete documentation can occur if workflow is not standardized especially in cases with interdisciplinary involvement. Documentation for patients undergoing magnetic resonance imaging (MRI) with anesthesia services was examined and revealed an opportunity for improvement to avoid financial losses. A preprocedure checklist to improve documentation and standardize workflow was implemented. We compared documentation from preintervention MRI to postintervention MRI with anesthesia services. Documentation that met the reimbursement requirements increased from 5% in the preintervention group to 90% in the postintervention group after the preprocedural checklist implementation. A cost estimate showed a reduction in potential revenue loss from preimplementation to postimplementation groups. The standardization of workflow with the aid of checklists helped meet the documentation requirements for adequate reimbursements and reduced the risk of potential reimbursement losses from payors. [ABSTRACT FROM AUTHOR]

• Applying CRM tools in ERD and patient transport contains many factors to consider. • Predetermined consensus (≥80%) was reached on 64 of 84 presented claims. • Theme Implementation of CRM method into ERD gained highest consensus. • Use of structured communication for lane changes gained the lowest consensus. • Further scientific research is needed to develop comprehensive recommendations. Emergency Response Driving (ERD) comprises a significant risk to safety in Emergency Medical Services (EMS). Crew Resource Management (CRM) tools play a major role in securing actions in high-risk procedures. The aim of this study was to find consensus on the important factors to consider when applying CRM tools in ERD and patient transport. ERD experts (n = 50) were recruited for a modified three-round Delphi study. Round 1 was based on previous research. The experts evaluated the items as important, neutral, or not important. The predetermined level of consensus was set at ≥ 80%. Answers given to the open-ended questions were analyzed using inductive content analysis. Predetermined consensus was reached on 64 of 86 presented items (74.4 %). The mean values of items reaching consensus varied between 3.81 and 4.86 on a five-point Likert scale. The items where consensus was reached were rated as "important" on a trichotomized scale. Multiple important factors to consider when applying CRM tools to ERD and patient transport were highlighted. This study provides valuable information to consider regarding EMS safety improvements. Further scientific research is needed to develop comprehensive recommendations. [ABSTRACT FROM AUTHOR]

Many principles of aviation safety have already been adopted into the field of health care. In this article, the author describes some of the core methodologies that contribute to the success of US Air Force fighter pilots and offers examples as to how these could be adapted to meet the challenges facing the practice of radiology. Key principles include "big picture" tactical training, the use of checklists, teamwork, safety, and performance improvement concepts. The need for cultural support of change is emphasized. [ABSTRACT FROM AUTHOR]

Background Adult surgical patient safety literature is plentiful; however, there is a disproportionate paucity of published safety work in the children's surgical literature. We sought to systematically evaluate the nature and quality of patient safety evidence pertaining to pediatric surgical practice. Methods Systematic search of MEDLINE and EMBASE databases and gray literature identified 1399 articles. Data pertaining to demographics, methodology, interventions, and outcomes were extracted. Study quality was assessed utilizing formal criteria. Results 20 studies were included. 14 (70%) comprised peer-reviewed articles. 18 (90%) were published in the last 4 years. 13 (65%) described a novel intervention, and 7 (35%) described a modification of an existing intervention. Median patient sample size was 79 (29–1210). A large number (n = 55) and variety (n = 35) of measures were employed to evaluate the effect of interventions on patient safety. 15 (75%) studies utilized a checklist tool as a component of their intervention. 9 (45%) studies [comprising handoff tools (n = 7); checklists (n = 1); and multidimensional quality improvement initiatives (n = 1)] reported a positive effect on patient safety. Quality assessment was undertaken on 14 studies. Quantitative studies had significantly higher quality scores than qualitative studies (61 [0–89] vs 44 [11–78], p = 0.03). Conclusions Pediatric surgical patient safety evidence is in its early stages. Successful interventions that we identified were typically handoff tools. There now ought to be an onus on pediatric surgeons to develop and apply bespoke pediatric surgical safety interventions and generate an evidence base to parallel the adult literature. Level of Evidence Level IV, Case series with no comparison group. [ABSTRACT FROM AUTHOR]

• Simulation-based training has an important role in maternity care. • The use of checklists can reduce human error and increase task completion. • Low- and high-fidelity approaches can achieve learning objectives. • Training must be tailored to suit the particular practice context. In this update we explore the current applications of simulation in obstetric anesthesia, describe what is known regarding its impacts on care and consider the different settings in which simulation programs are required. We will introduce practical strategies, such as cognitive aids and communication tools, that can be applied in the obstetric setting and share ways in which a program might apply these tools. Finally, we provide a list of common obstetric emergencies essential for a program's curriculum and common teamwork pitfalls to address within a comprehensive obstetric anesthesia simulation program. [ABSTRACT FROM AUTHOR]

Crisis checklists are cognitive aids used to coordinate care during critical events. Simulation training is a method to validate process improvement initiatives such as checklist implementation. In response to concerns staff members expressed regarding their comfort level when responding to infrequent occurrences such as cardiac arrest and other OR emergencies, the OR Comprehensive Unit-based Safety Program team at our facility decided to institute the use of crisis checklists in the OR during critical events. We provided 90-minute education sessions, simulation opportunities, and debriefings to help staff members become more comfortable using these checklists. Based on program evaluations, 80% of staff members who participated in the training expressed an increased comfort level when caring for a patient in cardiac arrest. [ABSTRACT FROM AUTHOR]

Background/purpose Children requiring gastrostomy/gastrojejunostomy tubes (GT/GJ) are heterogeneous and medically complex patients with high resource utilization. We created and implemented a hospital-wide standardized pathway for feeding device placement. This study compares hospital resource utilization before and after pathway implementation. Methods We performed a retrospective cohort study comparing outcomes through one year of follow-up for consecutive groups of children undergoing GT/GJ placement prepathway (n = 298, 1/1/2010–12/31/2011) and postpathway (n = 140, 6/1/2013–7/31/2014) implementation. We determined the change in the rate of hospital resource utilization events and time to first event. Results Prior to implementation, 145 (48.7%) devices were placed surgically, 113 (37.9%) endoscopically and 40 (13.4%) using image guidance. After implementation, 102 (72.9%) were placed surgically, 23 (16.4%) endoscopically and 15 (10.7%) using image guidance. Prior to implementation, 174/298 (58.4%) patients required additional hospital resource utilization compared to 60/143 (42.0%) corresponding to a multivariate adjusted 38% reduced risk of a subsequent feeding tube related event. Conclusions Care of tube-feeding dependent patients is spread among multiple specialists leading to variability in the preoperative workup, intraoperative technique and postoperative care. Our study shows an association between implementation of a standardized pathway and a decrease in hospital resource utilization. [ABSTRACT FROM AUTHOR]

Objectives Checklists are being introduced to enhance patient safety, but the results have been mixed. The goal of this research is to understand why time-outs and checklists are sometimes not effective in preventing surgical adverse events and to identify additional measures needed to reduce these events. Methods A total of 380 consecutive patients underwent complex cardiac surgery over a 24-month period between November 2011 and November 2013 at an academic medical center, out of a total of 529 cardiac cases. Elective isolated aortic valve replacements, mitral valve repairs, and coronary artery bypass graft surgical procedures (N = 149) were excluded. A time-out was conducted in a standard fashion in all patients in accordance with the World Health Organization surgical checklist protocol. Adverse events were classified as anything that resulted in an operative delay, nonavailability of equipment, failure of drug administration, or unexpected adverse clinical outcome. These events and their details were collected every week and analyzed using a systemic causal analysis technique using a technique called CAST (causal analysis based on systems theory). This analytic technique evaluated the sociotechnical system to identify the set of causal factors involved in the adverse events and the causal factors explored to identify reasons. Recommendations were made for the improvement of checklists and the use of system design changes that could prevent such events in the future. Results Thirty events were identified. The causal analysis of these 30 adverse events was carried out and actionable events classified. There were important limitations in the use of standard checklists as a stand-alone patient safety measure in the operating room setting, because of multiple factors. Major categories included miscommunication between staff, medication errors, missing instrumentation, missing implants, and improper handling of equipment or instruments. An average of 3.9 recommendations were generated for each adverse event scenario. Conclusions Time-outs and checklists can prevent some types of adverse events, but they need to be carefully designed. Additional interventions aimed at improving safety controls in the system design are needed to augment the use of checklists. Customization of checklists for specialized surgical procedures may reduce adverse events. [ABSTRACT FROM AUTHOR]

Background: In February 2010, the UK National Patient Safety Agency set a mandate that the World Health Organisation's Surgical Safety Checklist (SSC) should be completed for every surgical patient within the NHS in a bid to improve surgical safety. However since its introduction, there have been issues with checklist compliance, staff engagement and surgical serious incidents continue.Aims: This study seeks to explore if an unavoidable pre-recorded audio delivery of the SSC improves compliance and staff engagement with the checklist.Methods: The performance of the time-out and sign-out sections of the SSC were observed in three phases: standard practice, audio prompt and full audio delivery. Two researchers visited operating theatres throughout a three-week period. The outcome measures were occurrence of time-out/sign-out, completion of checklist, and presence, and engagement of staff during checklist administration. Staff feedback on the process was also sought.Results: Observation of time-out and sign-out was undertaken for 92 procedures. Time-out and sign-out were performed for 100% of the procedures when using full audio delivery of the SSC, an improvement on findings during the standard practice phase (time out- 97.4%, sign out- 86.8%). The compliance with completion of checklist items also improved with audio delivery of the SSC. However, the presence of all key staff and active participation of team members with the checklist was unaffected by the mode of delivery. Team members' self-reported engagement did not significantly vary across the different practices.Conclusion: The intervention seems to improve rate of checklist completion, particularly signout. It also brought more consistency on the questions read out during checklist administration. It doesn't necessarily ensure all key staff are present neither does it significantly improve staff engagement in the process. [ABSTRACT FROM AUTHOR]

Objective: To evaluate impact of WHO checklist compliance on riskadjusted clinical outcomes, including the influence of checklist components (Sign-in, Time-out, Sign-out) on outcomes. Background: There remain unanswered questions surrounding surgical checklists as a quality and safety tool, such as the impact in cases of differing complexity and the extent of checklist implementation. Methods: Data were collected from surgical admissions (6714 patients) from March 2010 to June 2011 at 5 academic and community hospitals. The primary endpoint was any complication, including mortality, occurring before hospital discharge. Checklist usage was recorded as checklist completed in full/partly. Multilevel modeling was performed to investigate the association between complications/mortality and checklist completion. Results: Significant variability in checklist usage was found: although at least 1 of the 3 components was completed in 96.7% of cases, the entire checklist was only completed in 62.1% of cases. Checklist completion did not affectmortality reduction, but significantly lowered risk of postoperative complication (16.9% vs. 11.2%), and was largely noticed when all 3 components of the checklist had been completed (odds ratio=0.57, 95% confidence interval: 0.37-0.87, P<0.01). Calculated population-attributable fractions showed that 14% (95% confidence interval: 7%-21%) of the complications could be prevented if full completion of the checklist was implemented. Conclusions: Checklist implementation was associated with reduced casemix- adjusted complications after surgery and was most significant when all 3 components of the checklist were completed. Full, as opposed to partial, checklist completion provides a health policy opportunity to improve checklist impact on surgical safety and quality of care. [ABSTRACT FROM AUTHOR]

In 1999 the Institute of Medicine (IOM) report “To Err is Human. Building a Safer Health System”, was a landmark publication that identified adverse events associated with surgery. The IOM report was effectively a wakeup call for a safer healthcare system for patients. Fourteen years later, much has been achieved, but patient safety still remains an important issue. The IOM report categorized incidents as nonsurgical and surgical, although nothing was specifically directed at spinal surgery. Some of the broad topics of concern that may relate to the spine were medication errors , infection , and technical problems of surgery. Almost 50% of adverse events identified in the IOM report were surgical in origin. Technical errors constituted the most frequent adverse events within surgery- however, the IOM did not specify what these were. According to other studies, we can deduce some of the most frequent technical issues in spine surgery; these include: wrong-level surgery, incomplete decompression, dural tears, battered root syndrome, and development of instability. We review the spinal patient pathway of the trauma patient, including pre-hospital and peri-operative care, and focus on strategies and campaigns to improve patient safety such as the WHO surgical safety checklist. [ABSTRACT FROM AUTHOR]

The successful and safe transfer of the patient from one phase of care to another is contingent on optimal communication by all team members. Nurses are often in a natural leadership position to improve safe practices during hand overs. A holistic understanding of the patient allows the perioperative nurse the opportunity to identify issues and choose a nursing diagnosis based on key elements of a patient’s needs and goals—information that should be relayed during patient transfers. This article reviews best practices in transfer-of-care communication to enable perioperative RNs to take an active, leading role in hand-over processes. [ABSTRACT FROM AUTHOR]

Rationale and Objectives To implement a preprocedural checklist in gastrointestinal (GI)/genitourinary (GU) fluoroscopy suites to assist radiology residents in performing studies with optimal fluoroscopic technique with a goal to lower radiation dose delivered to patients and operators. Materials and Methods We introduced a preprocedural checklist in the form of a mnemonic to first-year resident fluoroscopy operators. The checklist was augmented by teaching sessions at the fluoroscopy tower. Fluoroscopy time (FT) was collected for GI/GU fluoroscopy studies performed by first-year residents who did not use the checklist (year 1) and compared with FT from first-year residents who used the checklist for one full academic year (year 2). Residents in both groups were surveyed to assess their knowledge of radiation safety at the end of their respective radiology 1 (R1) academic years. Results A total of 778 examinations were analyzed from year 1, and 941 total examinations from year 2. After implementation of the checklist, mean FT for all studies decreased by 41.1 seconds ( P < .0001) in year 2 residents. Multivariate linear regression confirmed that year of examination was the strongest independent predictor of FT when other covariates such as resident age, gender, and experience and patient age and gender were included. Radiation safety knowledge was similar in both groups but self-reported confidence in safe fluoroscopy tower operation increased slightly in year 2 ( P = .144). Conclusions A visual preprocedural radiation safety checklist in GI/GU fluoroscopy was associated with a reduction in mean FT and may contribute to a culture of radiation safety awareness. [ABSTRACT FROM AUTHOR]

Turbuhaler and Diskus are commonly used powder inhaler devices for patients with respiratory disease. Their effectiveness is limited in part by a patient’s ability to use them correctly. This has led to numerous studies being conducted over the last decade to assess the correct use of these devices by patients and health care professionals. These studies have generally used device-specific checklists to assess technique, this being the most feasible and accessible method for assessment. However, divergence between the checklists and scoring systems for the same device in different studies makes direct comparison of results difficult and at times inappropriate. Little evidence is available to assess the relative importance of different criteria; however, brief patient training based on specific inhaler technique checklists leads to significant improvement in asthma outcomes. This paper reviews common checklists and scoring systems used for Turbuhaler and Diskus, discusses the problem of heterogeneity between different checklists, and finally recommends suitable checklists and scoring systems for these devices based on the literature and previous findings. Only when similar checklists are used across different research studies will accurate comparisons and meta-analysis be possible. [ABSTRACT FROM AUTHOR]

Approximately 2,700 patients are harmed by wrong-site surgery each year. The World Health Organization created the surgical safety checklist to reduce the incidence of wrong-site surgery. A project team conducted a narrative review of the literature to determine the effectiveness of the surgical safety checklist in correcting and preventing errors in the OR. Team members used Swiss cheese model of error by Reason to analyze the findings. Analysis of results indicated the effectiveness of the surgical checklist in reducing the incidence of wrong-site surgeries and other medical errors; however, checklists alone will not prevent all errors. Successful implementation requires perioperative stakeholders to understand the nature of errors, recognize the complex dynamic between systems and individuals, and create a just culture that encourages a shared vision of patient safety. [ABSTRACT FROM AUTHOR]

Abstract: Checklist Compliance is a term that has been used derisively in the information security community, implying that checklists are something used for paying lip service to security without instigating real changes to technology or processes. In this paper we argue that checklists can also be used as a practical tool to quickly establish a security baseline for water and wastewater systems. [Copyright &y& Elsevier]

Evidence-based principles should unquestionably play a key role in decision making. However, we must recognize that gaps in both knowledge and evidence occur in daily clinical practice. Subjective judgment can be a constructive component in making clinical decisions. The use of heuristics has been used both purposely and instinctively to help fill gaps and assist in solving complex dilemmas. A goal of this article is to encourage clinicians to assess their own decision-making skills as well as the skills of novices and experts with whom they work with. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: To retrospectively compare resident adherence to checklist-style structured reporting for maxillofacial computed tomography (CT) from the emergency department (when required vs. suggested between two programs). To compare radiology resident reporting accuracy before and after introduction of the structured report and assess its ability to decrease the rate of undetected pathology. Materials and Methods: We introduced a reporting checklist for maxillofacial CT into our dictation software without specific training, requiring it at one program and suggesting it at another. We quantified usage among residents and compared reporting accuracy, before and after counting and categorizing faculty addenda. Results: There was no significant change in resident accuracy in the first few months, with residents acting as their own controls (directly comparing performance with and without the checklist). Adherence to the checklist at program A (where it originated and was required) was 85% of reports compared to 9% of reports at program B (where it was suggested). When using program B as a secondary control, there was no significant difference in resident accuracy with or without using the checklist (comparing different residents using the checklist to those not using the checklist). Conclusions: Our results suggest that there is no automatic value of checklists for improving radiology resident reporting accuracy. They also suggest the importance of focused training, checklist flexibility, and a period of adjustment to a new reporting style. Mandatory checklists were readily adopted by residents but not when simply suggested. [Copyright &y& Elsevier]

Abstract: The World Health Organization Surgical Safety Checklist (WHO SSC) has demonstrated efficacy in developed and developing countries alike. Recent increases in awareness of surgical morbidity in developing countries has placed greater emphasis on strategies to improve surgical safety in resource-limited settings. The implementation of surgical safety checklists in low-income countries has specific barriers related to resources and culture. Adapting and amending existing surgical safety checklists, as well as considering factors unique to developing countries, may allow the potential of this simple intervention to be fully harnessed in a wider setting. This review will address the benefits and challenges of implementation of surgical safety checklists in developing countries. Moreover, inspiration for the original checklist is revisited to identify areas that will be of particular benefit in a resource-poor setting. Potential future strategies to encourage the implementation of checklists in these countries are also discussed. [Copyright &y& Elsevier]

Nearly half of all surgical complications are considered preventable. Early research regarding preprocedural surgical safety checklist briefings revealed that this process led to improved surgical complication rates. We conducted a literature search to gather evidence regarding compliance in conducting briefings, outcomes of brief- ings, and surgical team members' perceptions toward the use and efficacy of checklist brie?ngs. We found 23 studies conducted in 17 countries, the majority published since 2011, addressing these elements. The studies used a variety of methodologies and outcome measures. Common themes in the studies included enhanced patient safety, improved compliance over time, and increased communication among team members when checklists were used. As research continues on surgical safety checklists and briefings, a great opportunity exists for perioperative nurses to make contributions to the evidence. [ABSTRACT FROM AUTHOR]

FEATURE AT A GLANCE: Checklists, with their goal to increase adherence to protocols, are gaining popularity in health care despite some serious limitations. Here I present adherence engineering (AE), a conceptual framework that aims to increase adherence to protocols. AE provides guidance for the development of equipment that supports the successful completion of structured tasks. An example of how AE principles might be implemented is shown in the context of a clinical task in health care. Nonadherence to protocol when performing this task can have severe consequences for patient safety. The application of AE has the potential to improve human performance in a wide range of contexts. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) can present significant challenges in providing postoperative care. OSA policies have been developed and are in place within many facilities; however, a standard OSA protocol ensuring the safe delivery of postoperative care has not been universally accepted into practice. A synthesis of current OSA literature led to the development of a comprehensive evidence-based checklist to improve patient safety and direct the management of postoperative care for diagnosed or suspected OSA patients throughout their hospitalization. The checklist describes interventions for providing care in the immediate postoperative phase and sleep-specific interventions. These interventions include guidelines for postoperative assessment, continuous monitoring, extubation readiness, pain management, sleep positioning, respiratory monitoring, and continuous positive airway pressure therapy. The implementation of this checklist with the synergistic effect of the combined interventions may lead to a greater improvement in the care, safety, satisfaction, and clinical outcomes of OSA patients. [Copyright &y& Elsevier]

Abstract: Background: Intrahospital transfers are necessary but hazardous aspects of pediatric surgical care. Plan-Do-Study-Act processes identify risks during hospitalization and improve care systems and patient safety. Methods: A multidisciplinary team developed a checklist that documented patient data and handoffs for all intrahospital transfers involving pediatric surgical inpatients. The checklist summarized major clinical events and provided concurrent summaries by 3-month quarters (Q) over 1 year. Results: There were 903 intrahospital transfers involving 583 inpatients undergoing surgery. Total handoffs were documented in 436 (75% of 583), with greater than 1 handoff in 202 (46% of 436). Documented problems occurred in 31 transfers (3.4%), the most during Q1 (19/191; 9.9%). Incidence fell to 3.5% (9/260) in Q2, 0.4% (1/243) in Q3, and 1.0% (2/209) in Q4 (P < .001). Patient care issues (14/31; 45%) were most common, followed by documentation (10, 32%) and process problems (7, 23%). The quality improvement team was able to resolve patient instability during transport (5 in Q1, none in Q3, Q4) and poor pain control (3 in Q2, 1 in Q3, Q4). Of the patients, 3.2% had identified problems with patient care during intrahospital transfer. Conclusions: Plan-Do-Study-Act review emphasizes ongoing process analysis by multidisciplinary teams. Checklists reinforce communication and provide feedback on whether system goals are being achieved. [Copyright &y& Elsevier]

Checklists to guide critical procedures are becoming an increasingly important part of medical practice. These tools have proved effective in improving outcome in a variety of medical settings, including obstetrics. In this review, we outline essential principles of successful checklist creation and implementation and review our experience with checklist development in a worldwide, multiinstitutional health care delivery system. [ABSTRACT FROM AUTHOR]

Copyright of SHILAP Revista de Lepidopterologia is the property of Sociedad Hispano-Luso-Americana de Lepidopterologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This paper is an attempt to evaluate the ELT textbooks prescribed for study at the Pakistan Military Academy (PMA), Kakul. The aim of this paper is to determine the overall pedagogical value of the ELT textbooks towards this specific language programme. The merits and demerits of the textbooks are discussed in detail with reference to 7 common features developed from different evaluation checklists. The findings reveal that the syllabus is traditional in approach. The choice of any language teaching material must be made with the proper context in which the materials will be used. If the learners can see a close connection between the content of the material and their academic/professional/general needs, then there will be a strong motivating force for the language learners and better results will be achieved. Thus, it is suggested that instead of heavily literature based content, subject specific/general material should be included in the course. [ABSTRACT FROM AUTHOR]

Following the overwhelming evidence of adverse events in hospital practice, the World Health Organization (WHO)''s World Alliance for Patient Safety has launched the ‘Safe Surgery Saves Lives’ campaign, which has developed a surgical safety checklist aimed to improve patient safety. The implementation of this checklist has met with mixed reactions in different institutions. Many countries have still not adopted its use. In this article, a brief review is presented regarding the role of the WHO checklist, barriers to its implementation and strategies for successful adoption. [Copyright &y& Elsevier]

We report an update on obstetric patient safety efforts and results in the nation''s largest obstetric health care delivery system. The application of principles advocated by the Institute of Medicine a decade ago has resulted in reduced adverse outcomes, as reflected by claims experience. Particular progress has been made in standardization and documentation of critical processes, establishment of national quality benchmarks, reduction in elective deliveries <39 weeks'' gestation, and reduction in fatal postcesarean pulmonary embolism. Our experience provides a useful blueprint for similar progress in other health care systems. [Copyright &y& Elsevier]

Summary: Targets implemented at national or state levels have been employed in response to excessive numbers of adverse events (AEs) such as multiple antibiotic-resistant Staphylococcus aureus bacteraemias. Hospital resources are limited and setting such targets can result in resource diversion to dealing with the targeted AEs. There may be initial success as judged by decreasing counts but underlying problems are not necessarily addressed, and there is evidence that other non-targeted AEs may increase. Moreover, the values of individual observations can be greatly influenced by random variation. This can make it difficult using comparisons and targets to draw conclusions about the work of an institution. Although counting AEs is essential, the key to avoiding episodes of patient harm is prevention. This requires the implementation of evidence-based systems. These are already available for many AEs in the form of ‘bundles’ and checklists. When these systems are properly implemented and sustained, AE rates tend to occur at minimum predictable levels. Unfortunately, in spite of widespread knowledge and aggressive promotion, high levels of compliance have often been difficult to achieve and sustain. Better understanding and implementation of methods to sustain evidence-based systems are needed. Checklists, used as part of an overall system involving leadership and empowerment, application of evidence, culture change and measurement, may help to overcome this problem. [Copyright &y& Elsevier]

Healthcare in the United States is a complex process delivered in a variety of patient care settings that range from an emergency department to a long term care facility. The information necessary to provide this care is ideally based on evidenced based practice guidelines that are then translated into national standards of care. Of late, the legal community is increasingly looking to see if providers, including nurse practitioners, are documenting evidence-based care in the medical records of their patients. One such way to ensure universal application and documentation of appropriate care is through the use of evidence-based or best practice checklists to point out key aspects of care required for a given patient presentation. Over time, many experts are hopeful that access to appropriate patient care guidelines will be made more available with the advent and proliferation of computerized patient information management systems. [Copyright &y& Elsevier]

Summary: In this study, we developed and evaluated a Continuity of Care Checklist (CCC) to assist nurses in comprehensively reviewing practices related to continuity of care for orthopaedic patients discharged from hospital to community. The CCC was designed to ensure nurses would attend to multiple dimensions of continuity including informational continuity, relational continuity and management continuity. To evaluate the CCC, patients discharged from an orthopaedic unit (n =77) were interviewed about continuity of care. The CCC was then implemented and a second group of patients (n =77) was interviewed to examine changes in care. Structured interviews were also conducted with nurses (n =12) to learn about their experiences with the CCC. Interviews with patients revealed significant improvements in patient perceptions of information provision, involvement of informal caregivers in discharge, communication between hospital and community providers, consistency of information, and satisfaction with patient–provider relationships. Nurses who used the CCC found the tool improved standards for care and patient involvement in care. The CCC appears to be a practical tool for assisting nurses in systematically improving continuity of care among orthopaedic patients. Future directions for research and practice using the CCC are described. [Copyright &y& Elsevier]

Abstract: Rett Syndrome is one of the least commonly occurring autism spectrum disorders (ASD), but certainly one of the most devastating. A genetic profile has been identified, but checklists still have an important role for prescreening, especially before expensive genetic testing, and to provide precise strengths and weaknesses with respect to the core features of the disorder. Furthermore, research is now demonstrating subprofiles of genetic mutation which may be linked to profiles of behavioral responding and general symptom profiles. We review the literature on the nosology and assessment of Rett Syndrome in light of these developments. Specific symptoms and assessment techniques are discussed and potential future research avenues are reviewed with an eye to strengths and weaknesses of the current knowledge base. [Copyright &y& Elsevier]

Copyright of Baltic Journal of Road & Bridge Engineering (Baltic Journal of Road & Bridge Engineering) is the property of Baltic Journal of Road & Bridge Engineering and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Obstetric caregivers are plagued with lawsuits alleging negligence for suboptimal outcomes. Some of those claims are unjustified, but many have merit. We are obligated to create systems designed to minimize the potential for errors that harm our patients. A variety of safety initiatives have been shown to improve patient outcomes in several centers in the United States, but it has been difficult to document the expected association between those results and reduced liability premiums. Furthermore, some individuals and institutions have been reluctant to adopt safety tools such as electronic fetal monitoring certification for all staff working on their Labor and Delivery floor, protocols for managing common clinical scenarios, simulation drills for dealing with uncommon dangerous events, and pre-procedure checklists because of the paucity of evidence based data documenting the effectiveness of those approaches. It is time to move forward with these and other safety initiatives in a serious national attempt to eliminate all preventable adverse patient outcomes in our specialty. [ABSTRACT FROM AUTHOR]

Risk management should encompass a broad process of reporting adverse events and incidents, monitoring compliance and safety, and initiating quality improvement projects and activities. [ABSTRACT FROM AUTHOR]

Checklists have been long used as a cognitive aid in various high-stakes environments to improve the reliability and performance of individuals and teams. When designed well, implemented thoughtfully, and monitored closely, they offer the opportunity to improve the performance of health care teams and advance patient safety. There are different types of checklists; examples include task lists, troubleshooting lists, coordination lists, discipline lists, and to-do lists. Each is useful in different situations and requires different implementation strategies. Checklists also are different from algorithms, care maps and protocols, and educational tools. Therefore, they are not useful in all situations. In appropriate selected clinical circumstances, checklists are tools that can help standardize care, improve communication, and help teams perform optimally. [ABSTRACT FROM AUTHOR]

Objective: We conducted a literature search to examine the effects and experiences surrounding the transition from paper to electronic checklists in healthcare settings. We explore the types of electronic checklists being used in health care, how and where they were evaluated and seek to identify the successes and failures of using electronic checklists in healthcare, including use of checklists to ensure completeness of documentation in the electronic medical record.Background: Formalized checklist use as a memory and decision aid in aviation has resulted in significant increases in safety in that domain. Checklists have also been successfully introduced to reduce errors in some areas of healthcare; however, in some contexts checklists failed to provide some of the expected benefits. Adapting and integrating checklists electronically into the healthcare workflow provides opportunities and challenges that need to be better understood to make checklist adoption a success in health care.Method: We conducted a literature search of the English language literature in MEDLINE using PubMed for peer-reviewed literature of implementation and use of electronic or computerized checklists related to clinical or healthcare use. We reviewed the studies and included in this review those papers that discussed in depth the development process and that conducted controlled studies to assess the effectiveness of checklists and the evaluation of their acceptance in the clinical context.Results: The literature search using the keywords electronic checklist OR computerized checklist returned a total of 23 peer-reviewed papers. Out of these 15 were included in the review, with 8 excluded because they did not evaluate checklist use for patient care.Application: More rigorous application of known principles and methods from Human Computer Interaction research and the behavioral sciences can provide a clearer, more comprehensive understanding of the conditions that affect the development and use of checklists. [ABSTRACT FROM AUTHOR]