Search

Making a medical error is a uniquely challenging psychosocial experience for clinicians. Feelings of personal responsibility, coupled with distress regarding potential or actual patient harm resulting from a mistake, create a dual burden. Over the past 20 years, experiential accounts of making an error have provided evidence of the associated distress and impacts. However, theory-based psychosocial support interventions to improve both individual outcomes for the involved clinicians and system-level outcomes, such as patient safety and workforce retention, are lacking. There is a need for evidence-based ways to both structure and evaluate interventions to decrease the distress of making a medical error and its impacts. Such interventions play a role within wider programs of health professional support. We sought to address this by developing a testable, psychosocial model of clinician recovery after error based on recent evidence. Methods Systematic review methodology was used to identify studies published between January 2010 and June 2021 reporting experiences of direct involvement in medical errors and/or subsequent recovery. A narrative synthesis was produced from the resulting articles and used as the basis for a team-based qualitative approach to model building. Results We identified 25 studies eligible for inclusion, reporting evidence primarily from experiences of doctors and nurses. The identified evidence indicates that coping approach, conversations (whether they occur and whether they are perceived to be helpful or unhelpful), and learning or development activities (helpful, unhelpful or absent) may influence the relationship between making an error and both individual clinician outcomes of emotional impact and resultant practice change. Our findings led to the development of the Recovery from Situations of Error Theory model, which provides a preliminary theoretical basis for intervention development and testing. Conclusions The Recovery from Situations of Error Theory model is the first testable psychosocial model of clinician recovery after making a medical error. Applying this model provides a basis to both structure and evaluate interventions to decrease the distress of making a medical error and its impacts and to support the replication of interventions that work across services and health systems toward constructive change. Such interventions may be embedded into the growing body of peer support and employee support programs internationally that address a diverse range of stressful workplace experiences.

Background Errors and adverse events in the operating room (OR) are associated with not only poor technical performance but also deficits in nontechnical skills (NTSs). Numerous tools have been developed to assess NTS in the OR. Our aim was to conduct a systematic review of observational tools and report on their implementation and psychometric properties to guide healthcare professionals, educators, and researchers in tool selection and use. Methods A systematic literature search (January 1, 1990–May 28, 2019) was conducted across databases (MEDLINE, Embase, CINAHL, and PsycINFO) and reference lists of included studies. Reviewers independently screened articles for inclusion, assessed study quality, and extracted data. Results Thirty-one tools were identified across 88 studies, most commonly conducted in a real-world OR (n = 50), involving two observers (n = 50). The NTS of individuals (n = 62) were assessed more often than that of subteams (n = 21) or entire teams (n = 20). The NOn-Technical Skills for Surgeons demonstrated content validity, concurrent validity, predictive validity, and face validity across a range of studies. Oxford NOn-TECHnical Skills demonstrated content validity, concurrent validity, and predictive validity with good inter-rater reliability and test-retest validity. Conclusions The NOn-Technical Skills for Surgeons has the strongest evidence of validity and reliability for assessing individuals, whereas the most robust tool for evaluating teams was Oxford NOn-TECHnical Skills. We recommend continued investigation of these observational tools regarding their feasibility and reproducibility of methods. Further research is needed to determine the training requirements for observers and the potential of video and audio recordings in the OR.

Objective The operating room is a complex environment in which distractions, interruptions and disruptions (DIDs) are frequent. Our aim was to synthesize research on the relationships between DIDs and (i) operative duration, (ii) team performance, (iii) individual performance and (iv) patient safety outcomes in order to better understand how interventions can be designed to mitigate the negative effects of DIDs. Methods Electronic databases (MEDLINE, Embase, CINAHL and PsycINFO) and reference lists were systematically searched. Included studies were required to report the quantitative outcomes of the association between DIDs and team performance, individual performance and patient safety. Two reviewers independently screened articles for inclusion, assessed study quality and extracted data. A random-effects meta-analysis was performed on a subset of studies reporting total operative time and DIDs. Results Twenty-seven studies were identified. The majority were prospective observational studies (n = 15) of moderate quality. DIDs were often defined, measured and interpreted differently in studies. DIDs were significantly associated with extended operative duration (n = 8), impaired team performance (n = 6), self-reported errors by colleagues (n = 1), surgical errors (n = 1), increased risk and incidence of surgical site infection (n = 4) and fewer patient safety checks (n = 1). A random-effects meta-analysis showed that the proportion of total operative time due to DIDs was 22.0% (95% confidence interval 15.7–29.9). Conclusion DIDs in surgery are associated with a range of negative outcomes. However, significant knowledge gaps exist about the mechanisms that underlie these relationships, as well as the potential clinical and non-clinical benefits that DIDs may deliver. Available evidence indicates that interventions to reduce the negative effects of DIDs are warranted, but current evidence is not sufficient to make recommendations about potentially useful interventions.

Objective To identify individual and organisational factors associated with the prevalence, type and impact of unprofessional behaviours among hospital employees. Design, setting, participants Staff in seven metropolitan tertiary hospitals operated by one health care provider in three states were surveyed (Dec 2017 – Nov 2018) about their experience of unprofessional behaviours — 21 classified as incivility or bullying and five as extreme unprofessional behaviour (eg, sexual or physical assault) — and their perceived impact on personal wellbeing, teamwork and care quality, as well as about their speaking-up skills. Main outcome measures Frequency of experiencing 26 unprofessional behaviours during the preceding 12 months; factors associated with experiencing unprofessional behaviour and its impact, including self-reported speaking-up skills. Results Valid surveys (more than 60% of questions answered) were submitted by 5178 of an estimated 15 213 staff members (response rate, 34.0%). 4846 respondents (93.6%; 95% CI, 92.9–94.2%) reported experiencing at least one unprofessional behaviour during the preceding year, including 2009 (38.8%; 95% CI, 37.5–40.1%) who reported weekly or more frequent incivility or bullying; 753 (14.5%; 95% CI, 13.6–15.5%) reported extreme unprofessional behaviour. Nurses and non-clinical staff members aged 25–34 years reported incivility/bullying and extreme behaviour more often than other staff and age groups respectively. Staff with self-reported speaking-up skills experienced less incivility/bullying (odds ratio [OR], 0.53; 95% CI, 0.46–0.61) and extreme behaviour (OR, 0.80; 95% CI, 0.67–0.97), and also less frequently an impact on their personal wellbeing (OR, 0.44; 95% CI, 0.38–0.51). Conclusions Unprofessional behaviour is common among hospital workers. Tolerance for low level poor behaviour may be an enabler for more serious misbehaviour that endangers staff wellbeing and patient safety. Training staff about speaking up is required, together with organisational processes for effectively eliminating unprofessional behaviour.

Employee experiences of work-family-supportive coworker behavior (WFSCB) were investigated in a qualitative, inductively driven study. WFSCBs involve any action that one or more coworkers can take to facilitate one or more employees' WF balance in the work unit. The results of a content analysis based on 22 semi-structured interviews revealed five categories of WFSCBs including: demonstrating an understanding of the value of non-work life, emotional support, sharing resources and knowledge, facilitating work adjustments, and proactively developing solutions. A detailed description of each category, the specific behaviors they each include, and representative quotes are provided. Six categories of WFSCB antecedents were also identified including: knowledge of the coworker situation, similarity with coworker(s), relationship with coworker(s), ability to contribute to a change or improvement, perceived benefits of providing support, and personal characteristics. The results of this inductive research provide unique, evidence-based insights not only into various possible behaviors that coworkers can engage in to help each other better manage the demands of work and family, but also why they would display them.

Here, we provide a review of behavioural, cognitive, and neural studies of the thalamus, including its role in attention, consciousness, sleep, and motor processes. We further discuss neuropsychological and brain disorders associated with thalamus function, including Parkinson’s disease, Alzheimer’s disease, Korsakoff’s syndrome, and sleep disorders. Importantly, we highlight how thalamus-related processes and disorders can be explained by the role of the thalamus as a relay station.

© 2018 Background: Cyberchondria refers to an abnormal behavioral pattern in which excessive or repeated online searches for health-related information are distressing or anxiety-provoking. Health anxiety has been found to be associated with both online health information seeking and cyberchondria. The aims of the present systematic review and meta-analysis were to examine the magnitude of these associations and identify any moderator variables. Methods: A systematic literature search was performed across several databases (PsycINFO, PubMed, Embase) and reference lists of included studies. Results: Twenty studies were included across two independent meta-analyses, with 7373 participants. Random effects meta-analyses showed that there was a positive correlation between health anxiety and online health information seeking [r = 0.34, 95% CI (0.20, 0.48), p

Purpose The transfer of patient care from one health care worker to another involves communication in high-pressure contexts that are often vulnerable to error. This research project captured current practices for handoffs during the critical care stage of surgical recovery in a hospital setting. The objective was to characterize information flow during transfer and identify patterns of communication between nurses and physicians. Design and Methods Observations were used to document communication exchanges. The data were analyzed qualitatively according to the types of information exchanged and verbal behavior types. Findings Reporting and questions were the most common verbal behaviors, and retrospective medical information was the focus of information exchange. The communication was highly interactive when discussing patient status and future care plans. Nurses proactively asked questions to capture a large proportion of the information they needed. Conclusions Findings reflect positive and constructive patterns of communication during handoffs in the observed hospital unit.

Teamwork is prevalent in many work contexts. This study explored the similarities and differences in teamwork processes across different healthcare work contexts with the aim of assessing knowledge transfer feasibility. The research approach was to aggregate team communication analyses from four healthcare contexts to uncover teamwork similarities and differences. The four healthcare contexts included two handoffs and two surgery contexts. The communication analysis segmented communication into meaningful sequences. It categorized utterances into content categories and verbal behaviors. There were a few similar content categories across the four contexts. A clear information structure emerged in the two handoff contexts. In addition, there were more dialogues and requests in the surgeries compared to more reports in the handoffs. The content similarities suggest that some knowledge is transferable among the contexts. However, the differences in communication patterns reflect fundamental differences between handoff and surgery contexts in some teamwork processes. This research demonstrated that using communication analysis can uncover similarities and differences in team cognition and teamwork processes across work contexts. This in turn can help determine what knowledge and methods pertaining to team training, procedures, and technology are transferable across the contexts.

In this theoretical paper, we explain how employees’ passive and proactive followership behavior can influence the extent to which their managers display socialized or personalized charismatic leadership. We argue that followership behaviors influence managers’ positive affect and psychological empowerment, which in turn drive the degree to which managers manifest their particular charismatic leadership inclination. However, these effects would depend on the strength of managers’ predisposition for one type of charismatic leadership or the other. Implications for charismatic leadership theory and future research are discussed.

This study builds upon recent qualitative work-family (WF) research by developing and providing initial validation of a measure of work-family supportive coworker behaviors (WFSCB). The factor structure and correlates of the WFSCB measure were investigated in two studies. Findings from two exploratory factor analyses and one confirmatory factor analysis revealed that WFSCB is best represented by four dimensions including: emotional support, facilitating work adjustments, sharing resources and knowledge, and proactively developing solutions, all of which demonstrated adequate internal consistency. Results of a hierarchical regression analysis (N = 502 employees) provided preliminary evidence suggesting that WFSCB can significantly reduce work-to-family conflict, and improve WF balance, WF positive spillover, and life satisfaction. The utility of WFSCB as a source of informal workplace support was underscored based on evidence of its incremental validity in the prediction of these outcome variables over and...

This chapter provides a review of research methods reported in work–family (WF) articles published in peer-reviewed journals between 2004 and 2013. Methodological issues addressed include sampling (sampling methods, identification of target and source populations, response rate, and comparison of sample to source population), research designs (time horizon, laboratory vs. field setting, and level of control), data collection methods, levels of analysis, use of multiple data sources, triangulation, and the use of objective outcome measures. When possible, statistical comparisons were made between the results of this review and those reported in an earlier review by Casper, Eby, Bordeaux, Lockwood, and Lambert (2007). Results show that multiwave as well as qualitative research designs have been used more frequently since the period reviewed by Casper and colleagues. Still, there is room for improvement in the methodological rigor with which WF research is undertaken. In particular, WF scholars are encouraged to give more attention to sampling-related considerations, and to more strongly consider the use of experimental research designs, data/measurement triangulation, and the collection of data beyond the individual level of analysis.

The beginning of the general use of the scanning electron microscope (SEM) can be accurately dated to 1965 when the Cambridge Instrument Company in the U.K. marketed their Stereoscan 1 SEM (to be followed about 6 months later by JEOL in Japan). But development had been in progress intermittently over the previous 30 years in Germany, the U.S.A., France, and the U.K. where in 1948 work was begun in Charles Oatley’s department at the Cambridge University Engineering Department which led directly to the Stereoscan. The purpose of this paper is to trace the development of the SEM and to show that some of the ideas pul forward by the early workers were well ahead of their time and only became technologically practicable much later.The First proposal for the application of scanning to microscopy was made in 1928 by Synge, an Irish scientific dilettante, who conceived the near-field scanning optical microscope but did not attempt to build one.

Acquired Isodisomy for chromosome 13 is common in AML, and associated with FLT3-itd mutations

Energy loss rates for hot carriers in graphene have been measured using graphene produced by epitaxial growth on SiC, exfoliation, and chemical vapor deposition (CVD). It is shown that the temperature dependence of the energy loss rates measured with high-field damped Shubnikov-de Haas oscillations and the temperature dependence of the weak localization peak close to zero field correlate well, with the high-field measurements understating the energy loss rates by similar to 40% compared to the low-field results. The energy loss rates for all graphene samples follow a universal scaling of T-e(4) at low temperatures and depend weakly on carrier density proportional to n(-1/2), evidence for enhancement of the energy loss rate due to disorder in CVD samples. Funding Agencies|UK EPSRC||Swedish Research Council||Foundation for Strategic Research||UK National Measurement Office||EU

Patients with Philadelphia positive (Ph(+)) adult acute lymphoblastic leukaemia (ALL) have a poor prognosis. Stem cell transplantation (SCT) is increasingly being recognised as the treatment of choice in eligible patients with Ph(+)ALL, but disease-relapse remains a problem in a proportion of patients prior to and after SCT. Genetic abnormalities in addition to the Ph chromosome may influence the biology and clinical course of ALL, but there are not many studies on the potential genetic heterogeneity of adult Ph(+)ALL and clinical outcomes. Here, we report on five patients with ALL who were double Ph(+) and also had a high-hyperdiploid karyotype (Ph(+)/hyperdiploid) at diagnosis. In contrast to the presence of the Ph(+) chromosome, high-hyperdiploidy (50 chromosomes) as the sole karyotypic abnormality in ALL is associated with a favourable clinical outcome. In our series, four patients with a Ph(+)/hyperdiploid karyotype achieved a cytogenetic remission after induction chemotherapy and proceeded to stem cell transplantation (SCT). The fifth had five subclones including Ph(+)/hyperdiploid, as well as those that were only Ph(+); the latter emerged as the dominant clone after induction therapy and the patient died of disease-relapse. Of the patients who underwent SCT, only one relapsed, but achieved a durable remission with donor lymphocyte infusions. Thus, it is conceivable that the presence of high-hyperdiploidy as an additional karyotypic abnormality may confer a better prognosis to Ph(+)ALL, presumably by altering the kinetics of Ph(+) neoplastic cells. We have discussed these results in the context of recent studies on the significance of high-hyperdiploidy in Ph(+) adult ALL.

Summary Blood was collected by venepuncture from nine healthy subjects over a ten minute period before applying a standard tourniquet, and over a ten minute period afterwards. Plasma ionised calcium was unaltered by the tourniquet, whereas total calcium, total protein and albumin in serum increased modestly. However, there was no effect on total calcium adjusted for albumin. Even without albumin adjustment the change in total calcium was negligible within one minute of the application of the tourniquet. We consider that in ordinary clinical practice, there is no need to perform venepuncture for calcium assays without a tourniquet.

The resolution of a parallel recording electron energy loss spectrometer (PEELS) depends critically on the stabilities of the power supplies to the microscope column and the spectrometer over the period of the exposure. They may be the limiting factor in a dedicated scanning transmission electron microscope (STEM) with a field-emission electron gun (FEG), and improving them so that they are sufficiently stable can be a difficult task.An alternative approach is to compensate for any drift by deflecting the electron image of the spectrum leaving the spectrometer. The amount of deflection is that required to keep the zero-loss peak at a fixed position relative to the recording system. Such a stabiliser is being developed in the Microstructural Physics (MP) Group at the Cavendish Laboratory and a progress report is given here.The MP STEM is a VG Microscopes HB501 fitted with an Isaacson electron spectrometer. The normal accelerating potential is 100 kV and the FEG has an electron energy spread of about 0.25 eV. The spectrometer gives a dispersion of 1.8 pm per eV at the slit and from the evidence of very short exposures its resolution is adequate to match the FEG energy-spread in the absence of drift. A PEELS system with 3 quadrupoles and a YAG + CCD detector has been added, but the slit has been retained.

SUMMARY The development of the technology of the scanning electron microscope (SEM) is traced from the early pioneering work in the 1930s to the present day. Recent trends are described and, based on these, some speculative forecasts are made of possible future developments. It is suggested that these will include better vacuum conditions in conventional SEM to permit more accurate surface characterization, and improved electron optics for higher resolution, particularly with low-voltage operation.

In a dedicated scanning transmission electron microscope (STEM) secondary electron images with high spatial resolution and good contrast can be obtained. Two types of detector are described. These take into account the secondary electrons which depend on the post-specimen field strength of the objective lens. Due to the thinness of the samples and the collection geometry the images differ from those obtained in a convectional scanning microscope. Examples are given where secondary electron images augment the information obtained by the more commonly used imaging modes.

SUMMARY After a brief survey of the early development of the scanning electron microscope in Germany and the U.S.A., the paper describes the work on the subject that was carried out in the Cambridge University Engineering Department, particularly in the years 1948–53. This and later work led directly to the Stereoscan SEM marketed by the Cambridge Instrument Company in 1965. The paper is illustrated with a number of micrographs produced by early scanning electron microscopes.

Fifty years ago, in December 1937, Manfred von Ardenne submitted his first paper on the scanning electron microscope (SEM) to Zeitschrift für Physik. Moreover his eightieth birthday was on January 20th this year and it is therefore now very appropriate that we should remember the great contribution he made to the subject by that mainly theoretical paper and by the one he published a few months later on the practical realisation of the first scanning transmission electron microscope (STEM); both papers have been frequently cited in the literature. Von Ardenne designed a two-lens microscope and calculated the current in a 10nm focussed spot to be 10-12A; he also discussed how the detector should be arranged to give bright and dark field images from a transparent specimen and secondary electron images from a solid specimen. Unfortunately, at that time the only device available to him for amplifying such small currents was the thermionic valve and he quickly realised that the noise level would be much too high.

Description du detecteur utilise minimisant les effets de contraste de diffraction de particules cristallines ou de support et permettant la penetration d'echantillons epais. Utilisation pour les etudes sur les catalyseurs et application au cas de particule de platine sur differents supports

A parallel recording system is being built for the electron-energy-loss spectrometer of a VG Microscopes HB501 scanning transmission electron microscope (STEM). A two-dimensional charge-coupled device (CCD) lens-coupled to an ytrrium aluminium garnet (YAG) scintillator is the electron detector. The operating mode for the CCD is described and the expected performance compared with that of a detector using a self-scanned photodiode array. Provision is being made for the bright-field and energy-loss images to be produced.

A brief survey is given of the methods of examining opaque specimens in the electron microscope. The principle of the scanning electron microscope is described and mention is made of previous instruments. The design of such microscopes is discussed and the theoretical limit on performance is determined. The optimum scanning-beam voltage, beam current and scanning speeds are given. A recently built electrostatically focused scanning electron microscope for opaque specimens is described. This microscope has several new features, including: (a) The use of high-energy electrons to reduce the effects of surface contamination of the specimen. (b) Oblique scanning of the specimen, so that the image contrasts are formed by the topography of the etched surface of the specimen. (c) Direct amplification of the electron beam with an electron multiplier having beryllium-oxide-coated dynodes. (d) Direct viewing at low magnifications on a cathode-ray tube with a long-persistence screen, and photographic; ecording from the screen at high magnifications. Examples of micrographs of aluminium taken with the instrument are included and these show a resolution of about 500 A. It is concluded that higher resolutions could be obtained with this instrument if improved magnetic shielding and astigmatism correction were to be incorporated. Some measurements on the reflection of high-energy electrons are described in an Appendix.

The curvature of and stress in rectangular and circular thin mica windows in a vacuum tube are analysed and it is shown that a circular window has advantages. A method of pressing an electron-sensitive Melinex-based emulsion against a circular window is described and the results of tests on actual windows are reported. Details are given of the method used for making a vacuum-tight seal between mica and chrome-iron.

M82 is the nearest galaxy evidently containing a strong central source of energy, which is possibly similar to the nucleus of a Seyfert galaxy, and this seems to have given rise to an unusual explosive event1. The appearance of M82 is that of a flattened irregular system seen nearly edge-on, and if a distinct nucleus exists, it is highly obscured2 at optical wavelengths. Compact radio features are, however, present, and complex resolved radio and infrared sources and bright visible H II regions occupy an area ∼ 12″×35″ in the centre of the galaxy. The outer parts of the galaxy show linear optical polarisation, discovered by Elvius3. This is thought to arise from reflection in an extensive halo of dust particles of the light of the bright nucleus (or nuclear region) and of the galactic disk (for a recent discussion, see ref. 4). Consequently, observation of the polarisation can give information about the position and luminosity of the energetic nuclear region, and about the scattering medium. Outstanding questions about M82 involve the existence and nature of a compact nucleus and the morphological and evolutionary state of the whole galaxy.

A simple photocathode cooling device using the Peltier effect is described. The cathode temperature achieved is sufficiently low for the thermal emission from Sb-Cs and tri-alkali cathodes to be comparable with other sources of dark current in the image tube.

Publisher Summary This chapter provides an overview of an 8 cm electronographic image tube. The previous electronographic tube with a 4 cm diameter mica window displayed a number of problems, and it took longer than expected to produce tubes with satisfactory characteristics. The most time consuming of these problems were: (a) loss of photocathode sensitivity due to poisoning by residual gases, and (b) securing good contact between the nuclear emulsion and the mica window. Dark current had also been a problem in some tubes. The 4 cm tube has been used astronomically with the 36 inch telescope at Herstmonceux, and in Israel with the 40 inch at the Wise Observatory, Mitzpeh Ramon. The 8 cm tube includes a quadrant silicon diode for the use as an autoguider sensor. It is intended that an 8 cm tubes with autoguider should be mounted at the prime focus of the 98 inch Isaac Newton telescope. The tube will have a remotely controlled film changing mechanism with cassettes allowing five exposures. Acquisition of a guide star will also be remotely controlled using a TV camera on the finder telescope.

Publisher Summary This chapter describes an image tube for experimental electron optics. An easily demountable magnetically focused electronographic image tube has been built for the study of this type of electron optical system. The results obtained with it can be compared with theoretical studies and modifications can be easily made. The tube that is based on the 4 cm electronographic camera is continuously pumped with a diffusion pump and has an ultraviolet sensitive palladium photocathode. The tube therefore does not need to be baked, a procedure which could produce unpredictable changes in the electrode stack and in particular in the values of the resistors in the potential divider. The resolution patterns are photoengraved in chromium on the cathode plate in order to eliminate optical focusing. The limiting resolution over the whole image plane and the geometrical distortions can be measured simultaneously. The image drift of the tube has also been investigated. During the first half hour after switching on the high voltage the image drifts by between 2 and 5 μm. The image drift between two exposures taken one hour apart leaves the resolution of 200 lp mm −1 uninipaired showing that any image drift is less than 1 μm h −1 .