SUMMARY Review date: 1969 to 2003, 34 years. Background and context: Simulations are now in widespread use in medical education and medical personnel evaluation. Outcomes research on the use and effectiveness of simulation technology in medical education is scattered, inconsistent and varies widely in methodological rigor and substantive focus. Objectives: Review and synthesize existing evidence in educational science that addresses the question, ‘What are the features and uses of high-fidelity medical simulations that lead to most effective learning?’. Search strategy: The search covered five literature databases (ERIC, MEDLINE, PsycINFO, Web of Science and Timelit) and employed 91 single search terms and concepts and their Boolean combinations. Hand searching, Internet searches and attention to the ‘grey literature’ were also used. The aim was to perform the most thorough literature search possible of peer-reviewed publications and reports in the unpublished literature that have been judged for academic quality. Inclusion and exclusion criteria: Four screening criteria were used to reduce the initial pool of 670 journal articles to a focused set of 109 studies: (a) elimination of review articles in favor of empirical studies; (b) use of a simulator as an educational assessment or intervention with learner outcomes measured quantitatively; (c) comparative research, either experimental or quasi-experimental; and (d) research that involves simulation as an educational intervention. Data extraction: Data were extracted systematically from the 109 eligible journal articles by independent coders. Each coder used a standardized data extraction protocol. Data synthesis: Qualitative data synthesis and tabular presentation of research methods and outcomes were used. Heterogeneity of research designs, educational interventions, outcome measures and timeframe precluded data synthesis using meta-analysis. Headline results: Coding accuracy for features of the journal articles is high. The extant quality of the published research is generally weak. The weight of the best available evidence suggests that high-fidelity medical simulations facilitate learning under the right conditions. These include the following:

/pdf/features-and-uses-of-high-fidelity-medical-simulations-that-51wb8k5opy.pdf

Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review

Background Medication toxic effects and drug-related problems can have profound medical and safety consequences for older adults and economically affect the health care system. The purpose of this initiative was to revise and update the Beers criteria for potentially inappropriate medication use in adults 65 years and older in the United States. Methods This study used a modified Delphi method, a set of procedures and methods for formulating a group judgment for a subject matter in which precise information is lacking. The criteria reviewed covered 2 types of statements: (1) medications or medication classes thatshould generally be avoidedin persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available and (2) medications that should not be used in older persons known to havespecific medical conditions. Results This study identified 48 individual medications or classes of medications to avoid in older adults and their potential concerns and 20 diseases/conditions and medications to be avoided in older adults with these conditions. Of these potentially inappropriate drugs, 66 were considered by the panel to have adverse outcomes of high severity. Conclusions This study is an important update of previously established criteria that have been widely used and cited. The application of the Beers criteria and other tools for identifying potentially inappropriate medication use will continue to enable providers to plan interventions for decreasing both drug-related costs and overall costs and thus minimize drug-related problems.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/757456/ioi20821.pdf

Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts.

Naomi P. O'Grady, M.D., Mary Alexander, R.N. Lillian A. Burns, M.T., M.P.H., C.I.C. E. Patchen Dellinger, M.D. Jeffery Garland, M.D., S.M. Stephen O. Heard, M.D. Pamela A. Lipsett, M.D. Henry Masur, M.D. Leonard A. Mermel, D.O., Sc.M. Michele L. Pearson, M.D. Issam I. Raad, M.D. Adrienne Randolph, M.D., M.Sc. Mark E. Rupp, M.D. Sanjay Saint, M.D., M.P.H. and the Healthcare Infection Control Practices Advisory Committee (HICPAC).

/pdf/guidelines-for-the-prevention-of-intravascular-catheter-4xarsoczlz.pdf

Guidelines for the prevention of intravascular catheter-related infections, 2011

Some Unintended Consequences of Information Technology in Health Care: The Nature of Patient Care Information System-related Errors

High-quality health systems in the Sustainable Development Goals era: time for a revolution

Human beings, make errors Healthcare Services is a complex industry prone to accidents.The IOM Report [1] points out that some systems are more prone to accidents than others. When a system fails there are often multiple faults. In healthcare,human errors are the greatest contributors to accidents,however when human error is to blame it often depends upon failures within the system.These failures exists in the system before the error occurs, the same as with latent errors which are difficult to identify since they may be hidden in computers or within the various managerial layers. Most of the errors can be prevented by designing systems that make it hard for people to do the wrong thing and easy for people to do the right thing. In healthcare, this means designing processes that are able to ensure that patients are safe from accidental injury. As healthcare and the system that delivers it become more complex, the opportunities for errors abound. The IOM report “To Err is Human” proposes an approach for reducing medical errors and improving patient safety.The environment within which this occurs has a critical influence on quality.This influence may contain two dimensions; the first consists of the domain of quality which includes the practice that is consistent with current medical knowledge. The second dimension consists of forces in the external environment that can drive quality improvement in the delivery system. Although the risk of dying as a result of a medical error, far surpasses the risk of dying in an airline accident, public attention has been more focused on improving safety in the airline industry than in healthcare systems. Because of the absence of standardized nomenclature, it is important to define what an error is and what is an adverse event, the IOM Report defines them in the following way: “An error is the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.” An adverse event is an injury caused by medical management rather than the underlying condition of the patient. An adverse event attributable to error is a “preventable adverse event”.

To err is human. Building a safer health system

Current and future Burden of Communicable Diseases in the European Union and EEA/EFTA countries (BCoDE). Methodology protocol

Medication errors occur in all health care systems and in all health care settings If the errors are identified through an active management and effective reporting system they can be removed before they can cause harm to patients In order to reduce the risk it is important to understand the causes of medication errors The NHS Report aims to provide a guide to current knowledge of the frequency, nature and causes of errors, the risk factors inherent in current medication processes and helping the NHS organizations and health professionals in achieving a reduction in serious medication errors In July 2001 the UK Government established the National Patient Safety Agency (NPSA, http:// wwwnpsanhsuk) which, in 2004, implemented a national reporting and learning system to enable the NHS to report all type of adverse incidents including those involving medicines The NPSA core purpose is to improve patient safety and to accomplish this task; it looks at the identification of patterns and trends in avoidable adverse events so that the NHS can entrust practice and management to reduce the risk of recurrence Before the establishment of the NPSA, there had been no attempt to establish a unified mechanism for reporting and analyzing medication errors Despite the many published studies there is no clear definition for medication errors and thus they do not distinguish between errors and adverse drug reactions The Report defines and highlights the differences between medical errors and drug reactions

Building a Safer NHS for Patient. Improving Medication Safety

Background : The number of indicators aiming to provide a clear picture of healthcare needs and the quality and efficiency of healthcare systems and services has proliferated in recent years. The activity of the National Observatory on Health Status in the Italian Regions is multidisciplinary, involving around 280 public health care experts, clinicians, demographers, epidemiologists, mathematicians, statisticians and economists who with their different competencies, and scientific interests aim to improve the collective health of individuals and their conditions through the use of “core indicators”. The main outcome of the National Observatory on Health Status in the Italian Regions is the “Osservasalute Report – a report on health status and the quality of healthcare assistance in the Italian Regions”. Methods : The Report adopts a comparative analysis, methodology and internationally validated indicators. Results : The results of Observatory Report show it is necessary: • to improve the monitoring of primary health care services (where the chronic disease could be cared) through implementation of clinical path;  • to improve in certain areas of hospital care such as caesarean deliveries, as well as the average length of stay in the pre-intervention phase, etc.; • to try to be more focused on the patients/citizens in our health care services; • to practice more geographical interventions to reduce the North-South divide as well as reduce gender inequity. Conclusions : The health status of Italian people is good with positive results and outcomes, but in the meantime some further efforts should be done especially in the South that still has to improve the quality and the organization of health care services. There are huge differences in accuracy and therefore usefulness of the reported data, both between diseases and between Regions.

Laura Murianni

Papers

To err is human. Building a safer health system

Current and future Burden of Communicable Diseases in the European Union and EEA/EFTA countries (BCoDE). Methodology protocol

Building a Safer NHS for Patient. Improving Medication Safety

The Observatory Health Report