A review of medical error taxonomies: A human factors perspective

Although a large number of medical error taxonomies have been published, there is little evidence to suggest that these taxonomies have been systematically compared. This paper describes a study comparing 26 medical error taxonomies using a human factors perspective. The taxonomies were examined to determine if they classified systemic factors of medical errors and if they utilized theoretical error concepts in their classifications. Scope of classification was also examined. It was found that two-thirds of the taxonomies classified systemic factors of medical errors and only a third utilized theoretical error concepts. Medical error taxonomies based on theoretical error concepts were more likely to be generic in applicability and also more likely to classify systemic factors and psychological error mechanisms of medical errors. In addition to terminology, the medical error taxonomies also varied in terms of domain-specificity, granularity, and developmental process. Different medical error taxonomies provide different information; how these differences affect medical error management needs to be investigated.     

IRRIGATION DEVELOPMENT AND MANAGEMENT ALTERNATIVES OF A DOLOMITE AQUIFER IN NORTHEASTERN ILLINOIS1

ABSTRACT: Irrigation development of the dolomite aquifer in eastera Kankakee and northern Iroquois Counties, Illinois, is extensive and increasing. Interruptions of domestic supplies have been reported with increasing frequency during the 1980's. To address this issue, a regional assessment of the ground-water resources of the region was conducted in 1987 and 1988. Options for managing the dolomite aquifer were also investigated. Hydrogeology of the dolomite aquifer was determined using five aquifer tests. Tranamissivity values of the dolomite aquifer ranged from 14,000 to 50,000 gpd/ft (168 to 600 m³/m/day). Storage coefficients were between 0.0001 and 0.0002, within the range of a confined (artesian) aquifer. Based on flow-net analyses, recharge of the dolomite aquifer ranged from 85,000 to 285,000 gpd/mi² (124.4 to 417.0 m³/day/km²). Water levels of the dolomite aquifer were mapped during five periods in 1987 and 1988 by measuring up to 226 wells completed in the dolomite aquifer. Maximum regional water-level declines because of irrigation pumpage were 44 feet (13.4 m) in 1987 and 72 feet (21.9 m) during the drought of 1988. Based on ground-water use data, precipitation records, and hydrogeologic information, the magnitude of water-level declines can be attributed more to differing hydrogeologic conditions than to pumpage or climatic changes. Existing ground-water management methods for resolving conflicts over the ground-water resources of the study area are reviewed and alternative management options explored.     

EFFECTS OF DIVERSIONS ON THE NORTH AMERICAN GREAT LAKES1

ABSTRACT: Water level fluctuations of the Great Lakes often have created regional controversies among the states and Canadian provinces that share this vast resource. Even though the 100-year range of their water levels is only four to five feet, episodes of high and low Great Lakes water levels have been a recurring problem throughout the twentieth century. The possibility of increased diversion and consumptive use has exacerbated the existing conflicts over how to manage this water resource. A research project evaluated the effects of interbasin diversion on the Great Lakes system and on the industries that depend on the maintenance of historical water levels, namely hydropower and commercial navigation. The simulation approach employed in this research and some of the important findings are presented. The approach is similar to that used in recent government studies of Great Lakes water level regulation. Several significant modifications were made specifically addressing the diversion issue. Aggregate annual impacts to hydropower and shipping resulting from a diversion of 10,000 cubic feet per second were found to vary from 60 to 100 million dollars. Increases in impacts as a function of diversion rate are nonlinear for the navigation industry.     

Safety climate

Safety climate, the objective measurement of attitudes and perceptions toward Occupational Health & Safety (OH&S) issues, has been largely ignored and measures such as lost time and frequency rate have been used to determine the efficacy of OH&S programs. Yet, it is clear that measuring the precursors of accidents identified in a safety climate analysis provides a powerful proactive management tool. This paper reports on safety climate factors found in clerical and service organizations in Australia. Concurrent validity studies are reported. In contradistinction to published studies, it is argued that safety climate factors are not stable across organizations. The significance of this for planning and assessing the efficacy of OH&S programs is discussed. It is concluded that although safety climate factors are not stable, the safety climate factor pattern identified in organizations provides a powerful management tool for designing OH&S programs.     

Major hazards—Thinking the unthinkable

It is a common experience that public administrations tend to shy away from the explicit acknowledgment of quantitative risk levels. Faced with extreme concentrations of population and of industrial activities, including LPG and liquid chlorine storage, within a very small land area, Hong Kong has faced up to the issue of major man-made hazards by “thinking the unthinkable” and adopting explicit risk guidelines. This article describes how these guidelines were developed and the arguments that led to their adoption. It is emphasized that the risk guidelines are not rigid standards but simply a method of focusing decision making and ensuring that any decision to contravene the guidelines is taken at an appropriately senior level in the administration. The way in which the guidelines have been incorporated intimately into the planning and decision-making process is described and details are given on how this has led to the implementation of a variety of measures that have greatly reduced both societal and individual risk from certain types of chemical storage and chemical processing installations in Hong Kong. The opinions in this paper represent the views of the authors and not necessarily those of the Hong Kong Government.     

Rapid interphase analysis for prenatal diagnosis of translocation carriers using subtelomeric probes

Interphase fluorescence in situ hybridization (FISH) has become an accepted laboratory technique for the rapid and preliminary prenatal assessment of chromosome aneuploidy. The introduction of subtelomeric FISH probes now allows for the molecular–cytogenetic analysis of terminal chromosome rearrangements. In a prospective study, we examined the prenatal use of subtelomeric probes on interphase cells to rapidly detect the carrier status of a fetus when a parent carried a known reciprocal or Robertsonian chromosome translocation. Three of the cases were identified as being abnormal. All cases were confirmed by routine cytogenetic analysis. These findings clearly demonstrated the utility of this technique and these probes to rapidly and correctly identify balanced and unbalanced chromosome anomalies of a fetus that could result from parental translocations. Copyright © 2002 John Wiley & Sons, Ltd.     

Prenatal measurement of the fetal cerebellum and cisterna cerebellomedullaris by ultrasound

The fetal cerebellum can be visualized with ultrasound throughout the second trimester. We describe a technique for measuring the transverse and anteroposterior cerebellar diameters and the measurement of the cisterna magna in the same plane between 14 and 32 weeks gestation. Nomograms for these measurements against gestational age showed good correlation, and narrow confidence limits for the transverse cerebellar diameter. The transverse cerebellar diameter was also measured directly in 79 fetuses after mid-trimester abortion and the measurements obtained were compared with the ultrasound TCD nomogram. Good correlation, was obtained between the post mortem measurements and the ultrasound TCD nomogram. Routine use of these measurements and nomograms should prove valuable in the diagnosis of congenital abnormality of the posterior fossa and may also be of use in assessing the effect of severe intrauterine growth retardation and other insults on cerebellar growth and development. The narrow confidence limits obtained with the TCD nomogram should enable it to be used with confidence in clinical practice.     

Effectiveness of mandatory license testing for older drivers in reducing crash risk among urban older Australian drivers

Most licensing jurisdictions in Australia maintain mandatory assessment programs targeting older drivers, whereby a driver reaching a specified age is required to prove his or her fitness to drive through medical assessment and/or on-road testing. Previous studies both in Australia and elsewhere have consistently failed to demonstrate that age-based mandatory assessment results in reduced crash involvement for older drivers. However studies that have based their results upon either per-population or per-driver crash rates fail to take into account possible differences in driving activity. Because some older people maintain their driving licenses but rarely if ever drive, the proportion of inactive license-holders might be higher in jurisdictions without mandatory assessment relative to jurisdictions with periodic license assessment, where inactive drivers may more readily either surrender or lose their licenses. The failure to control for possible differences in driving activity across jurisdictions may be disguising possible safety benefits associated with mandatory assessment. The current study compared the crash rates of drivers in Melbourne, Australia, where there is no mandatory assessment and Sydney, Australia, where there is regular mandatory assessment from 80 years of age onward. The crash rate comparisons were based on four exposure measures: per population, per licensed driver, per distance driven, and per time spent driving. Poisson regression analysis incorporating an offset to control for inter-jurisdictional road safety differences indicated that there was no difference in crash risk for older drivers based on population. However drivers aged 80 years and older in the Sydney region had statistically higher rates of casualty crash involvement than their Melbourne counterparts on a per license issued basis (RR: 1.15, 1.02-1.29, p=0.02) and time spent driving basis (RR: 1.19, 1.06-1.34, p=0.03). A similar trend was apparent based on distance travelled but was of borderline statistical significance (RR: 1.11, 0.99-1.25, p=0.07). Collectively, it can be inferred from these findings that mandatory license re-testing schemes of the type evaluated have no demonstrable road safety benefits overall. Further research to resolve this on-going policy debate is discussed and recommended.     

Nitrogen removal and nitrate leaching for two perennial,sod-based forage systems receiving dairy effluent

In northern Florida, year-round forage systems are used in dairy effluent sprayfields to reduce nitrate leaching. Our purpose was to quantify forage N removal and monitor nitrate N (NO3(-)-N) concentration below the rooting zone for two perennial, sod-based, triple-cropping systems over four 12-mo cycles (1996-2000). The soil is an excessively drained Kershaw sand (thermic, uncoated Typic Quartzip-samment). Effluent N rates were 500, 690, and 910 kg ha(-1) per cycle. Differences in N removal between a corn (Zea mays L.)-bermudagrass (Cynodon spp.)-rye (Secale cereale L.) system (CBR) and corn-perennial peanut (Arachis glabrata Benth.)-rye system (CPR) were primarily related to the performance of the perennial forages. Nitrogen removal of corn (125-170 kg ha(-1)) and rye (62-90 kg ha(-1)) was relatively stable between systems and among cycles. The greatest N removal was measured for CBR in the first cycle (408 kg ha(-1)), with the bermudagrass removing an average of 191 kg N ha(-1). In later cycles, N removal for bermudagrass declined because dry matter (DM) yield declined. Yield and N removal of perennial peanut increased over the four cycles. Nitrate N concentrations below the rooting zone were lower for CBR than CPR in the first two cycles, but differences were inconsistent in the latter two. The CBR system maintained low NO3(-)-N leaching in the first cycle when the bermudagrass was the most productive; however, it was not a sustainable system for long-term prevention of NO3(-)-N leaching due to declining bermudagrass yield in subsequent cycles. For CPR, effluent N rates > or = 500 kg ha(-1) yr(-1) have the potential to negatively affect ground water quality.