No reduction in adverse medical events over six years despite efforts

Article found in ScienceDaily, Nov 24, 2010.

Despite concerted efforts, no decreases in patient harm were detected at 10 randomly selected North Carolina hospitals between 2002 and 2007, according to a new study from the Stanford University School of Medicine, Harvard Medical School and the Institute for Healthcare Improvement.

Since a 1999 Institute of Medicine report sounded the alarm about high medical error rates, most U.S. hospitals have changed their operations to keep patients safer. The researchers wanted to assess whether these patient-safety efforts reduced harm. They studied hospitals in North Carolina because that state has shown a particularly strong commitment to patient safety.

“We found that harm rates — in a state that was very engaged in patient safety — did not change over time. This was a little surprising to all of us,” said senior study author Paul Sharek, MD, who is an associate professor of pediatrics at Stanford and chief clinical patient safety officer at Lucile Packard Children’s Hospital. “Our findings are a call to action for the health-care system. We need a nationwide strategy for reducing harm from medical care.”

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No reduction in adverse medical events over six years despite efforts.

See Also on This Topic

The Diagnostic Error in Medicine
3rd International Conference
Toronto, Canada
October 25-27, 2010

http://www.smdm.org/diagnostic_errors/agenda_conference_schedule.shtml

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Learning from Diagnostic Mistakes – Past, Present, & Future

Kaveh G. Shojania, MD, Sunnybrook Health Sciences Centre

Abstract: Dr. Shojania will draw on his extensive experience in studying diagnostic error through the lens of medical autopsy (the historical gold standard for diagnostic error recognition) to reflect on the present and future of diagnostic error detection and feedback systems.

Click here to view the VIDEO for this session

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Oral Abstracts: Diagnostic Reasoning, Accuracy, Tools, Errors
Click here to view the complete abstract for each of the 4 oral presentations

Methods for Studying the Cognitive Causes of Diagnostic Error: A Systematic Review.
Martine Nurek, MSc, Brendan C. Delaney, MD and Olga Kostopoulou, PhD

Thought Process Effects in Diagnostic Decisions.
Marieke De Vries, PhD, MA, Cilia L. M. Witteman, PhD, Leontien de Kwaadsteniet, PhD, John Van den Bercken, PhD, Rob W. Holland, PhD and Ap Dijksterhuis, PhD

Diagnostic Errors in Adult Intensive Care Units: A Systematic Review of Autopsy Studies.
Bradford Winters, MD, PhD, Jason W. Custer, MD, Atul Nakhasi, B.S., Victoria Goode, B.A., Karen Robinson, B.S., David E. Newman-Toker, MD, PhD and Peter J. Pronovost, MD, PhD, FCCM

Diagnostic Errors are Common Causes of Adverse Events in Hospitalized Canadian Children.
Anne Matlow, MSc, MD, FRCPC, Catherine M. G. Cronin, MD, MBA, FRCPC, FRCPI, FAAP, Virginia Flintoft, MSc, BN, Cheri Nijssen-Jordan, MD, MBA, Mark Fleming, MA, MSc, PhD, Barbara Brady-Fryer, BSc, MN, PhD, RN, Mary-Ann Hiltz, CHIM, MHA Candidate, Elaine Orrbine and G. Ross Baker, PhD

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DEM Poster Presentations
Click here to view the complete abstract for each of the 40 poster presentations

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More programs……..

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Can Evidence-Based Medicine Help Reduce Diagnostic Error?
Click here to listen to the AUDIO Recording for this session 2 hrs
Speakers:

• R. Brian Haynes, MD, MSc, PhD, McMaster University
• Gordon Guyatt, BSc, MD, MSc, McMaster University
• Barbara Bowers Jones, MLS, J. Otto Lottes Health Science Library, University of Missouri – Columbia
• Ann McKibbon, BSc, MLS, PhD, McMaster University

Abstract: This session will include platform presentations by two of the world leaders in the science and practice of evidence-based medicine. Each will offer a unique perspective on the relationship between EBM and the future of diagnostic error reduction. Prof. Haynes will focus on the search for and synthesis of evidence related to diagnosis, while Prof. Guyatt will focus on the critical appraisal of diagnostic studies and the dissemination and teaching of EBM related to bedside diagnosis. Experts in library science will offer personal experiences and perspectives being embedded with healthcare teams to provide evidence at the bedside. A panel discussion with interactive questions and answers will follow.

OvidSP: A New Look and Added Functionality

OvidSP has a new look and additional functionality. Some of the enhancements include a new main search page design for more effective search and browse navigation, “drag-and-drop” customization features, consolidation of features and pages, and more. Read on for highlights of the new OvidSP 3.0 and a comparison chart.

For individual or group instruction in OvidSP contact:
Shandra Protzko, Information Specialist
Knowledge and Library Services
K104, Goodman Bldg
303.398.1343
protzkos@njhealth.org

My Account
Use your current account ID and password or create an account.
Your My Account ID & Password provides access to My Workspace which contains My Projects, My Searches & Alerts, and My eTocs, and the option to install the OvidSP Toolbar. Your account also stores your Annotations and any custom settings.

My Projects
You must create an account or use an existing account.
My Projects is the “core” of My Workspace, where users can assemble all of their research materials and organize them into distinct work projects.
• Group citations (with Annotations if attached), articles, images, search strategies, images, eTOCs, and other PDF and HTML files into distinct folders and projects.
• Upload additional documents from your hard drive.

Adding to My Projects
You will need to create a project or select an existing project or folder.
Items from within OvidSP that may be added to a project include:
• Search results and saved searches
• Journal articles
• Images
• Text Snippets (using the Snippet Tool)
• Book chapters from Books@Ovid
• AutoAlert results
External items that may be added:
• User-created citations
• Links to external resources via OvidSP Toolbar
• User-uploaded files

eTOCs
You will need to enter your email address.
Automatically receive notices via email or RSS when tables of contents for new journal issues are available. To use this feature select the My Workspace and My TOCs

Results Tools
Widgets allow you to instantly view and sort results according to multiple criteria. Plus narrow your search by using the Filter By tool. The Results Tools, to the left of the citations, can be hidden or displayed as desired.

Comparison Chart (download as .pdf)

Old OvidSP Main Page Return by clicking Main Search Page Access Saved Searches and Alerts View Saved Searches and AutoAlerts using either the link at the top right or the button in the Search History box Search Aid • Search Aid includes Your Search, Filter by Star Ranking when in Basic Search mode, and Narrow Search • Search Aid can be displayed or closed Results Manager • Results Manager handles all results actions • Always present after execution of search My eTOCs  (table of contents) Management of eTOCS available only in Browse Journal mode Browse Journal From Main Search Page there are two links to journals: • Your Journals@Ovid to access subscribed full text journals • All Journals to view all Journals@Ovid

New OvidSP 3.0 Main Page Click Search tab to get to the main page Access Saved Searches and Alerts Now available from My Workspace on the upper navigation bar and still available from Search History box Results Tools • All sections can now be collapsed/expanded as needed • Additional filtering options available Print, Email, Export Action Icons • Chose an action to format output • Can now output to Microsoft® Word, PDF, RIS, and multiple bibliographic management programs My eTOCs (table of contents) Management of eTOCs now located under My Workspace – My eTOCs Browse Journals • One link opens Journals A-Z allowing user to filter by availability • From Journals A-Z list, select My Subscriptions to view only subscribed journals (i.e. Your Journals@Ovid) My Projects • Create projects and folders within projects • Store citations, searches, full text, graphics and other items

Question: In EndNote, Where are All the Other Connections, Filters and Styles?

Question: I used to see tons of Connections, Filters and Styles. Now I just see 100 of each. Where are all the rest?

Answer: You need to “install” them into EndNote. They are already on your hard drive. You just need to bring them into the EndNote program by customizing it. Here are the instructions for the Mac and PC.

“Importing” more Filters, Connections Files, and Styles in EndNote X2 or X3

MacIntosh

Exit Word

Under the Endnote Menu, go to Customizer

Open the three sections and choose items of interest as you like or those recommended by the librarian:

• Connections (to databases NJH has access to):
  • OCLC
  • Other Databases
  • OVID
• Import Filters:
  • NLM
  • OCLC
  • Other Databases
  • OVID
• Output Styles
  • Behavioral Sciences
  • Export
  • Generic
  • Life Sciences
  • Medicine
  • Nursing
  • Science
  • Social Sciences
  • Veterinary Medicine

After selecting Sets that you want:

• Click Next
• Click Next
• Click Done

Windows

Go to:  Start –> Control Panel –> Add or Remove files –> Endnote X3

Click on Change

Choose Modify

Expand the lists  by clicking on the + sign next to

• Additional Connections,
• Additional Filters
• Additional Styles

Choose items of interest as you like or those recommended by the librarian above under the Mac Section. Select this way:

• Click in the X
• Choose  –> Will be installed on local hard drive

After selecting sets that you want:

• Click Next
• Click Next
• Wait while Installation occurs.
• Click Finish
• Close out of Control Panel.

Now, When you look in the appropriate “Manager,” you will see a long list. Put a check in the box to see them in your short list.

Workflow Tools for the Academic Publishing Ecosystem

As digital content accelerates, the pace of literature consumption, discovery tools and work flow technologies play a growing role in the publishing industry and scientific reading. The spectrum of players include authors, publishers, librarians, and the reader. The work flow of reading is changing constantly. In the old days, scientists had to walk two miles in the snow to the medical library to photocopy an article. Then, after reading, they stored the paper copy in large filing cabinets.

Today, literature consumers search PubMed or Ovid and then downloads a PDF of any article that interests them. Or they can read it on the screen. They no longer have to walk through that snow to the library but the library staff works long hours setting up the OpenURL systems that make this work flow happen with a click-and-download system.

The literature consumer can download articles one at a time, can attach them to their EndNote library, or can store them on their hard drive. Now this work flow is changing. There are new technologies in Beta test. And we are bringing you three in this library newsblog. In two of them you can download multiple selected articles with one click and in another you can rent articles for 24 hours for 99 cents.

These new technologies only work with the latest browser versions and require plugins or add-ons.

Finding Full Text using EndNote 13

Using EndNote 13, you can set up the utility called Find Full Text in the EndNote preferences as explained in the above linked blog post. You highlight from 1 to a 1000 references, hit Find Full Text, and after several passes, the PDFs all come in and are linked to your EndNote record. If the journal is not owned by NJH Tucker Library, Endnote downloads a PubMed URL where affilitated users can see if UCDenver owns it.

PubGet

Using PubGet, you can search directly on the PubGet page. If NJH Tucker Library owns the title, you can read the PDF copy of multiple articles, right there on the webpage WITHOUT downloading it. It’s like a preview. Then you can download it if you want. You can sign in and save some keepers. From your keeper list of 15, you click on download PDFs and you can download with one click all those we own or that are open access. There is an interface with PubMed called PaperPlane to download multiple articles from search results.

DeepDyve

Using DeepDyve, you can rent an article and read its full-text for up to 24 hours for as little as $0.99! These articles can only be viewed at DeepDyve and cannot be downloaded, printed or shared. You can preview the first page before you rent. There a link to download from the publisher which you can try before you rent if you think it’s owned by NJH Tucker Library or open access.

Both PubGet and DeepDyve use search engine type searching returning thousands of results. Both are in Beta and don’t always work. PubGet is quirky on the Mac and will not work with Windows IE v.6.

See other blog posts for details on these three work flow technologies.

EndNote X3 – Finding Full Text

This works best with EndNote libraries where the citations have been downloaded from PubMed or Ovid. If manually entered or edited, the appropriate system connections often cannot be made.

Set up your Endnote Preferences

(found under the EndNote X3 menu)

[To use this system, you must enable Web browser cookies. If you have not consciously disabled them, they are probably enabled.]

Set your Display Fields choices:

From the EndNote X3 menu –> Preferences –> Display Fields

Rearrange your display fields so you can see that you have a filed attachment.

Suggested arrangement:

Add Access to Your Institution’s Library

Tucker Medical Library has a system to make journal articles accessible with an OpenURL Path. This is the OpenURL web address to the Tucker online library. It is where EndNote will be directed to search for matching references.

You need the appropriate OpenURL path for EndNote 13. It is:

http://bl7ur7bu2p.search.serialssolutions.com/

From the Endnote X3 menu –> Preferences –> Find Full Text

• Enter  this URL in the OpenURL path box
• Check:
  • DOI
  • PubMed
  • OpenURL
• Uncheck ISI web of Knowledge
• Save

To find and retrieve full text:

1. Select the reference(s) to which you want to add full text.
2. In the library window, you can highlight up to 1000 references. For example, you can select a single reference, or hold down the Command or control key to highlight individual references, or use Edit –> Select All to select an entire Group of displayed references. Or, open an individual reference for editing.
3. From the References menu, select Find Full Text –> Find Full Text. (Using a Windows machine, if you have a reference open, you can use the right-click contextual menu to select Find Full Text.)
4. EndNote begins searching for and downloading full text for the selected references. Full text downloading happens in the background, which may affect the performance of other operations.
5. To the lower left, you will see the Find Full Text reporting area where it will tell you that it is searching, has found or not found the PDF or has found a URL. Click on any of these menus and you will retrieve the number of articles indicated. Tucker Library may own the article even though Endnote did not find it.
6. This system will not work for accessing remotely the holding of the University of Colorado Denver Health Sciences Library because they do not use a true proxy system.
7. EndNote does find the URL of journals that are online but not owned by NJH Tucker Library. Using the PubMed URL, you can go to PubMed and find the articles. To see the FindIt! icon, you need to follow these steps:
   1. Open a new browser window or tab
   2. Go to the Tucker Library Website and click on PubMed to activate the specialized URL in this browser.
   3. Go back to you citation and reload the page. The NJH FindIt! Icon will appear.
   4. Use it to get the article from UCDenver if affiliated, or from interlibrary loan.

To attach a file manually

If you have a full text copy of any remaining articles that did not get the Full Text this way, you can link this copy to its record manually.

1. Place your cursor in the File Attachments field
2. Use Menu: References –> File Attachments –> Attach File
3. Browse and locate your file
4. You can attach more than one file