Cognitive errors are a major contributor to medical error. Traditionally, medical errors at teaching hospitals are analyzed in morbidity and mortality (M&M) conferences. We aimed to describe the frequency of cognitive errors in relation to the occurrence of diagnostic and other error types, in cases presented at an emergency medicine (EM) resident M&M conference. We conducted a retrospective study of all cases presented at a suburban US EM residency monthly M&M conference from September 2011 to August 2016. Each case was reviewed using the electronic medical record (EMR) and notes from the M&M case by two EM physicians. Each case was categorized by type of primary medical error that occurred as described by Okafor et al. When a diagnostic error occurred, the case was reviewed for contributing cognitive and non-cognitive factors. Finally, when a cognitive error occurred, the case was classified into faulty knowledge, faulty data gathering or faulty synthesis, as described by Graber et al. Disagreements in error type were mediated by a third EM physician. A total of 87 M&M cases were reviewed; the two reviewers agreed on 73 cases, and 14 cases required mediation by a third reviewer. Forty-eight cases involved diagnostic errors, 47 of which were cognitive errors. Of these 47 cases, 38 involved faulty synthesis, 22 involved faulty data gathering and only 11 involved faulty knowledge. Twenty cases contained more than one type of cognitive error. Twenty-nine cases involved both a resident and an attending physician, while 17 cases involved only an attending physician. Twenty-one percent of the resident cases involved all three cognitive errors, while none of the attending cases involved all three. Forty-one percent of the resident cases and only 6% of the attending cases involved faulty knowledge. One hundred percent of the resident cases and 94% of the attending cases involved faulty synthesis. Our review of 87 EM M&M cases revealed that cognitive errors are commonly
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Hospitalized patients are susceptible to medication errors, which represent between the fourth and the sixth cause of death. The department of intra-hospital pharmacovigilance intervenes in the entire process of medication with the purpose to prevent, repair and assess damages. To analyze medication errors reported by Mexican Fundación Clínica Médica Sur pharmacovigilance system and their impact on patients. Prospective study carried out from 2012 to 2015, where medication prescriptions given to patients were recorded. Owing to heterogeneity, data were described as absolute numbers in a logarithmic scale. 292 932 prescriptions of 56 368 patients were analyzed, and 8.9% of medication errors were identified. The treating physician was responsible of 83.32% of medication errors, residents of 6.71% and interns of 0.09%. No error caused permanent damage or death. This is the pharmacovigilance study with the largest sample size reported. Copyright: 2018 SecretarÍa de Salud.
The advent of modern solar energy technologies can improve the costs of energy consumption on a global, national, and regional level, ultimately spanning stakeholders from governmental entities to utility companies, corporations, and residential homeowners. For those stakeholders experiencing the four seasons, accurately accounting for snow-related energy losses is important for effectively predicting photovoltaic performance energy generation and valuation. This paper provides an examination of a new, simplified approach to decrease snow-related forecasting error, in comparison to current solar energy performance models. A new method is proposed to allow model designers, and ultimately users, the opportunity to better understand the return on investment for solar energy systems located in snowy environments. The new method is validated using two different sets of solar energy systems located near Green Bay, WI, USA: a 3.0-kW micro inverter system and a 13.2-kW central inverter system. Both systems were unobstructed, facing south, and set at a tilt of 26.56. Data were collected beginning in May 2014 (micro inverter system) and October 2014 (central inverter system), through January 2018. In comparison to reference industry standard solar energy prediction applications (PVWatts and PVsyst), the new method results in lower mean absolute percent errors per kilowatt hour of 0.039 and 0.055%, respectively, for the micro inverter system and central inverter system. The statistical analysis provides support for incorporating this new method into freely available, online, up-to-date prediction applications, such as PVWatts and PVsyst.
One way to reduce uncertainty in scientific measurement is to devise a protocol in which more quantities are measured than are absolutely required, so that the result is over constrained. This report develops a method for so combining data from two different tests for air leakage in residential duct systems. An algorithm, which depends on the uncertainty estimates for the measured quantities, optimizes the use of the excess data. In many cases it can significantly reduce the error bar on at least one of the two measured duct leakage rates (supply or return), and it provides a rational method ofmore reconciling any conflicting results from the two leakage tests. less
Moral absolutes have little or no moral standing in our morally diverse modern society. Moral relativism is far more palatable for most ethicists and to the public at large. Yet, when pressed, every moral relativist will finally admit that there are some things which ought never be done. It is the rarest of moral relativists that will take rape, murder, theft, child sacrifice as morally neutral choices. In general ethics, the list of those things that must never be done will vary from person to person. In clinical ethics, however, the nature of the physician-patient relationship is such that certain moral absolutes are essential to the attainment of the good of the patient - the end of the relationship itself. These are all derivatives of the first moral absolute of all morality: Do good and avoid evil. In the clinical encounter, this absolute entails several subsidiary absolutes - act for the good of the patient, do not kill, keep promises, protect the dignity of the patient, do not lie, avoid complicity with evil. Each absolute is intrinsic to the healing and helping ends of the clinical encounter.
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