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Rook, Mieneke. "Living kidney donor safety insights & outcome /." [S.l. : [Groningen : s.n.] ; University Library Groningen] [Host], 2009. http://irs.ub.rug.nl/ppn/.
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RinaldiFuller, Julie. "Patient to nurse ratios and safety outcomes for patients." [Denver, Colo.] : Regis University, 2008. http://165.236.235.140/lib/JRinaldiFuller2008.pdf.
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Deng, Lucy. "Seizures following vaccination: risk, outcome and recurrence." Thesis, The University of Sydney, 2021. https://hdl.handle.net/2123/27195.
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Background
An adverse event following immunisation is any untoward medical occurrence that follows
immunisation and does not necessarily have a causal relationship with the usage of the vaccine.
Seizures, ranging from the common and mostly benign febrile seizure to the life-threatening status
epilepticus, that occur following immunisation are considered adverse events following immunisation.
Febrile seizures have been observed to occur in defined periods following vaccination when a fever is
most likely to occur. The magnitude of risk attributed to specific vaccines varies, with no known
increased risk seen for some vaccines. Status epilepticus, continuous seizure activity for 5 minutes or
more without return of consciousness, or recurrent seizure activity without a return to baseline
consciousness in between, has also been reported following vaccination, though the magnitude of
attributable risk is unclear. Both seizure types are rare, but serious adverse events, that can follow
and sometimes be triggered by immunisation. Because of the potential risk of neurodevelopmental
sequalae, seizures can affect both provider and consumer confidence in vaccine safety and therefore
immunisation coverage.
Knowledge gaps on seizures following vaccination include their clinical severity, developmental
outcomes, genetic risks and revaccination outcomes. In my thesis, I aimed to address these gaps to
better inform immunisation providers about the risks and outcomes of these potentially serious
adverse events following immunisation, to improve guidance on their assessment and management,
and ultimately to improve parent and consumer confidence in vaccine safety.
Febrile seizures following vaccination
In this thesis, I set out to assess the clinical severity, neurodevelopmental outcome and genetic risk of
febrile seizures following vaccination, to supplement the known attributable risk of febrile seizures
following specific vaccines. Vaccine proximate seizures were defined as VPS was defined as a
seizure within 14 days of a vaccination encounter, based on previous studies on the timing of fever
and febrile seizures following specific vaccines. I examined the clinical severity of vaccine-proximate febrile seizures through a multi-site prospective cohort study. I discovered that febrile seizures most
commonly occurred following the first dose of measles-containing vaccine, and were not clinically any
different to febrile seizures due to another cause such as a viral illness. The only factor that prolonged
hospitalisation in children with a vaccine-proximate febrile seizure was the presence of concomitant
laboratory-confirmed infection. A subsequent prospective case-control study was conducted to assess
developmental and behavioural outcomes, and to identify the presence of genetic variants in children
with vaccine-proximate febrile seizures compared to children with non-vaccine-proximate febrile
seizures and no history of seizures. Using standardised developmental tests administered by certified
assessors blinded to the child’s medical history and standardised parent-completed questionnaires,
this study found no increased risk of developmental or behavioural problems in children with vaccineproximate
febrile seizures compared to children with non-vaccine-proximate seizures or no history of
seizures. Genetic variants in the sodium channel gene, SCN1A, associated with a severe form of
epilepsy were only identified in children with prolonged vaccine-proximate febrile seizures.
Status epilepticus following vaccination
Prior to this thesis, there were only case reports and case series on vaccine-proximate status
epilepticus, presenting an incomplete and potentially biased picture of the risk and severity of vaccineproximate
status epilepticus that may not be generalisable to the whole population. Using a
retrospective, population-based, record-linked cohort linking birth, immunisation, hospitalisation and
death data, I was able to determine that less than 4% of first episode status epilepticus in children
was vaccine proximate. Similar to vaccine-proximate febrile seizures, status epilepticus was found to
occur most commonly following the first dose of measles-containing vaccine, but at a rate 35 times
lower than that of vaccine-proximate febrile seizure for the same risk window. There was no difference
in clinical severity, measured by duration of hospitalisation, intensive care unit admission or death,
between vaccine-proximate and non-vaccine-proximate status epilepticus cases. The predictor for
ongoing seizures subsequent to the first status epilepticus was seizure onset prior to the status
epilepticus episode. Importantly, vaccination uptake decreased following status epilepticus,
regardless of the proximity of the status epilepticus episode to vaccination. These findings were
confirmed in a second retrospective cohort study I conducted using medical record review to validate
the findings from the larger population-based retrospective study that relied on hospital administrative data. The retrospective cohort study also found morbidity following vaccine-proximate status
epilepticus was associated with the presence of an underlying genetic epilepsy, where the seizures
are the result of a known or presumed genetic defect.
Revaccination outcomes following vaccine-proximate seizures
Following the identification of the risk and outcome of seizures following vaccination, the next logical
clinical question to address was can these children safely proceed with subsequent vaccinations and,
if so, how? I, therefore, examined the risk of seizure recurrence following revaccination in children
with a previous vaccine-proximate seizure. Through a 5-year multi-site retrospective cohort study, I
reviewed the clinical management and outcomes of children with a history of vaccine-proximate
seizures who presented to a Specialist Immunisation Clinic, a specialist clinic at tertiary paediatric
hospitals where children with a vaccine proximate seizure are provided specialised medical
assessment and management for subsequent vaccinations. Vaccine-proximate seizure recurrence
was found to be more likely in children with an underlying genetic epilepsy, in particular Dravet
syndrome. Reassuringly, the risk of seizure recurrence decreased with the use of prophylactic
benzodiazepine with vaccination in these children.
Conclusions
Vaccination is one of the most effective public health measures for reducing the burden of infectious
diseases. However, the success of vaccination programs has been threatened by vaccine hesitancy,
that is, the reluctance or refusal to vaccinate despite vaccine availability. Concerns regarding the
safety of vaccines and their potential long-term neurological sequalae are amongst the complex
reasons why people choose not to vaccinate.
My doctoral research has contributed to vaccine safety knowledge globally, specifically in the
understanding of seizures, specifically febrile seizures and status epilepticus, as severe acute
neurological events following vaccination. In this thesis, I not only identified the children most at risk of
neurological sequelae following a vaccine-proximate seizure, but also a revaccination management
plan that would allow these children to continue vaccinations without placing them at risk of further vaccine-proximate seizures. These are children aged <12 months, whose underlying genetic epileptic
encephalopathy is unmasked by a vaccination event. These children typically present with status
epilepticus following vaccination, and are most likely to have further seizures with revaccination if it is
given without additional precautions in the form of prophylactic benzodiazepine. My thesis finding
highlights the importance of, and future work required to better understand, adversomics – the
immunogenetics and immunogenomics of vaccine adverse events at the individual and population
level, respectively – and its implications on vaccine safety, confidence and uptake.
Finally, my thesis incorporates a variety of research methods, from retrospective record-linked cohort
studies to examine whole-of-population risk, retrospective multi-site clinic-based cohort studies to
examine detailed clinical management and outcomes, and prospective case-control studies to test
hypotheses. I have demonstrated the unique contribution of each of these research methods and the
strength in combining these to form a broader pharmacovigilance program of research that can help
inform both risk and outcome at a population and individual level. By applying the doctoral research
skills I have acquired, I aim to continue my work as a vaccine safety clinician researcher in the
monitoring and investigation of vaccine safety signals for novel vaccines, including the multiple
COVID-19 vaccines currently in early use globally, to ensure the continued safe and effective use of
vaccines in the years to come.
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Arun, Ashutosh. "A novel Road User Safety Field Theory for traffic safety assessment applying video analytics." Thesis, Queensland University of Technology, 2022. https://eprints.qut.edu.au/234039/1/Ashutosh_Arun_Thesis.pdf.
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This thesis introduces a new Road User Safety Field Theory to proactively assess traffic safety by studying the interactions of various road users at signalised intersections. The proposed theory combines road traffic environmental factors, vehicle capabilities and personal characteristics to determine the extent and strength of road users’ safety ‘bubble’ or field across various traffic interactions. By applying the Artificial Intelligence-based video data analytics, the proposed Road User Safety Field Theory is found to better estimate crash risks in terms of crash frequency and severity than traditional traffic conflict techniques.
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Murray, Brett Richard. "The use of emergency lights and sirens by ambulances and their effect on patient outcome and public safety." Thesis, Boston University, 2013. https://hdl.handle.net/2144/21225.
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Thesis (M.A.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.The use of emergency lights and sirens as warning devices by ambulances is a hotly debated topic within the Emergency Medical Services. For the last few decades, research has shown that lights and sirens have only a minimal effect on time required to transport patients to the hospital, and essentially no positive effect on patient outcome. Meanwhile, thousands of ambulance crashes occur every year (usually during the operation of lights and sirens), and its possible that's tens of thousands of crashes are occurring as a result of a passing ambulance, though not directly involving the ambulance itself. This paper is meant to provide a thorough review of the science behind the use of lights and sirens, the risks they pose to EMS providers, patients, and the public, and strategies to help curb the cost they pose both in dollars and lives. The available literature on this subject all points to the use of lights and sirens being out dated, ineffective, and dangerous, and yet almost nothing has been done to solve the problems they cause. Continued research and development is needed to help make ambulances safer for their occupants, more effective driver training programs need to be offered to EMS providers, and protocols need to be adopted to limit the unnecessary use of L&S.
2031-01-01
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Hakalahti, A. (Antti). "Efficacy and safety of radiofrequency catheter ablation in the treatment of atrial fibrillation." Doctoral thesis, Oulun yliopisto, 2015. http://urn.fi/urn:isbn:9789526209500.
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Abstract Atrial fibrillation (AF) is a common arrhythmia in the clinical setting with a population prevalence of 1–2%. AF significantly increases the risk of stroke and death, worsens coexistent heart diseases and may leave the patient with disabling symptoms. The treatment of AF consists of the control of the underlying conditions, prevention of complications and symptom relief by controlling heart rate (rate control) or by targeting normal rhythm (rhythm control), with the latter achieved either by antiarrhythmic drug (AAD) therapy or catheter ablation (CA). Ablation therapy has generally been applied and studied after failure of AAD therapy. The aim of this study was to evaluate the safety and efficacy of first-line CA in AF. The other objectives were to assess the safety of continuous warfarin therapy during CA and to identify prognostic markers for treatment outcome. A meta-analysis of all randomised studies and a secondary analysis of one randomised study comparing CA and AAD as first-line therapy were performed. In the first study, ablation therapy reduced AF recurrences more than AAD therapy (HR 0.63) when provided as first-line therapy; the rate of complications was similar with both therapies. Some of the complications of ablation therapy were more serious than those encountered with AADs. The second study revealed that the antiarrhythmic efficacy of ablation therapy was more durable. In the third study, the efficacies of continuous and interrupted warfarin therapy were compared in 228 procedures; both strategies were found to be equally safe during a three month follow-up. Furthermore, an analysis of 2317 AF episodes revealed a new electrocardiographic feature at AF initiation, which was associated with AF relapse after the initiation of therapy. Finally, a thorough echocardiographic examination was performed in 49 patients prior to ablation therapy. Mild diastolic dysfunction was associated with AF recurrence. In conclusion, CA was more effective as a first-line therapy than AADs but may cause more severe complications. Continuous warfarin therapy was found to be safe during CA. New electrocardiographic and echocardiographic markers for treatment outcome were recognisedTiivistelmä Eteisvärinä on yleinen rytmihäiriö, jonka esiintyvyys väestössä on 1–2 % luokkaa. Eteisvärinä lisää merkittävästi kuolleisuutta ja aivoinfarktiriskiä, vaikeuttaa muiden sydänsairauksien oireita ja saattaa aiheuttaa invalidisoivia oireita. Eteisvärinän hoito keskittyy liitännäissairauksien hoitoon ja komplikaatioiden estoon sekä oireiden lievitykseen joko syketaajuutta säätämällä (sykkeenhallinta) tai pyrkimällä normaaliin rytmiin (rytminhallinta). Rytminhallinnassa käytetään yleisesti joko rytmihäiriölääkkeitä tai katetriablaatiohoitoa. Eteisvärinän katetriablaatiota on useimmiten käytetty ja tutkittu tilanteessa, jossa rytmihäiriölääkitys on osoittautunut tehottomaksi. Tämän tutkimuksen tavoitteena oli arvioida eteisvärinän katetriablaatiohoidon tehoa ja turvallisuutta ensilinjan hoitona. Muina tavoitteina oli katetriablaation turvallisuuden arviointi jatkuvan varfariinihoidon aikana sekä löytää uusia katetriablaatiohoidon tehoa ennustavia tekijöitä. Teimme meta-analyysin kaikista randomisoiduista tutkimuksista ja sekundaarisen analyysin yhdestä randomisoidusta tutkimuksesta, jotka vertasivat rytmihäiriölääke- ja katetriablaatiohoitoa ensilinjan hoitona. Ensimmäisessä työssä ablaatiohoito esti eteisvärinän uusiutumista tehokkaammin (riskisuhde 0.63), eikä komplikaatioiden yleisyydessä ollut eroa hoitojen välillä. Jotkut ablaatiohoitoon liittyvät komplikaatiot olivat kuitenkin luonteeltaan vakavampia kuin lääkehoidossa. Ablaatiohoidon eteisvärinää estävä vaikutus todettiin pidempikestoiseksi toisessa työssämme. Kolmannessa työssä vertasimme jatkuvaa ja tauotettua varfariinihoitoa 228 ablaatiotoimenpiteen aikana. Molemmat lähestymistavat osoittautuivat yhtä turvallisiksi 3 kuukauden seuranta-aikana. Analysoimme edelleen 2317 eteisvärinäkohtausta ja löysimme osalla potilaista uuden eteisvärinäkohtauksen alkuun liittyvän ominaisuuden, joka oli yhteydessä rytminhallinnan tehottomuuteen. Lisäksi teimme 49 potilaalle laajan sydämen ultraäänitutkimuksen ennen katetriablaatiotoimenpidettä. Diastolisen dysfunktion havaittiin olevan yhteydessä eteisvärinän uusiutumiseen. Yhteenvetona totesimme että katetriablaatiohoito on rytmihäiriölääkehoitoa tehokkaampaa ensilinjan hoitona, mutta siihen mahdollisesti liittyvät komplikaatiot olivat luonteeltaan hankalampia. Jatkuva varfariinihoito todettiin turvalliseksi katetriablaation yhteydessä. Löysimme lisäksi sydänsähkökäyrästä ja sydämen ultraäänitutkimuksesta uusia hoidon tehoa ennustavia tekijöitä
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Nelms, Mark David. "Development of in silico models to support repeat dose safety assessment of cosmetic ingredients to humans." Thesis, Liverpool John Moores University, 2015. http://researchonline.ljmu.ac.uk/4424/.
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Cosmetic products are used daily on a global scale. Therefore, it is necessary to ensure that these products, and their ingredients, do not cause any adverse human health effects under normal usage; to ensure this, risk assessment must be performed. Traditionally, risk assessments are performed in vivo, i.e. conducting tests on animals using the chemical(s) of interest. However, over the past decade there has been an increase in research into the use of alternative toxicity testing methods, such as in vitro, in chemico and in silico. Whilst there are a number of alternative techniques that may be employed, no one method can be used in isolation as a full replacement for an in vivo test. Therefore, the Adverse Outcome Pathway (AOP) concept is an emerging method by which information provided by the in vitro, in chemico, and in silico approaches can be utilised in an integrated testing strategy. The AOP concept links an upstream molecular initiating event to a downstream adverse outcome, via a number of testable key events. In silico approaches utilise computers in order to develop predictive models. Within the AOP paradigm in silico method work to identify the key features of a chemical (structural alerts) that induce a molecular initiating event (MIE). A collection of structural alerts that induce the same MIE are considered to be an in silico profiler. Typically, these in silico profilers are supported by associated toxicity, or mechanistic, information pertaining to the ability to induce a specific MIE. The overall aim of the work presented in this thesis was the development of an in silico profiler, based upon the hypothesis that the induction of mitochondrial toxicity is a key driver of organ-level toxicity. The research presented herein demonstrates the ability to identify, and develop, two types of structural alert; mechanism- and chemistry-based; that pertain to mitochondrial toxicity. Due to the differences inherent in these two types of alert they should be utilised for different purposes. As such, the main usage of the mechanism-based alerts should be in the formation of chemical categories and subsequent data gap filling via read-across. In comparison, the chemistry-based alerts should be utilised for the purposes of prioritising chemicals, within an inventory, that should undergo additional testing in in vitro and/or in chemico assays. It is envisaged that these two types of structural alerts could be used to profile chemical inventories as part of a tiered testing strategy. Therefore, the future work discussed in detail the need to expand the chemical space covered by the alerts. Additional future work involves utilising experimental information from in vitro/in chemico assays to verify the mechanism-based alerts and to refine the chemistry-based alerts by discerning mechanistic information associated with them. Furthermore, it is envisaged that these alerts could be incorporated into predictive tools, such as the OECD QSAR Toolbox, to enable their use for screening and prioritisation purposes.
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Bunch, Jacinda Lea. "Rapid response systems : evaluation of program context, mechanism, and outcome factors." Diss., University of Iowa, 2014. https://ir.uiowa.edu/etd/1558.
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Prevention of in-hospital cardiac arrest (IHCA) is critical to reducing morbidity and mortality as both the rates of return to pre-hospital functional status and overall survival after IHCAs are low. Early identification of patients at risk and prompt clinical intervention are vital patient safety strategies to reduce IHCA. One widespread strategy is the Rapid Response System (RRS), which incorporates early risk identification, expert consultation, and key clinical interventions to bedside nurses caring for patients in clinical deterioration. However, evidence of RRS effectiveness has been equivocal in the patient safety literature.
This study utilized a holistic Realistic Evaluation (RE) framework to identify important clinical environment (context) and system triggers (mechanisms) to refine our understanding of an RRS to improve local patient emoutcomesem and develop a foundation for building the next level of evidence within RE research. The specific aims of the study are to describe a RRS through context, mechanism, and outcome variables; explore differences in RRS outcomes between medical and surgical settings, and identify relationships between RRS context and mechanism variables for patient outcomes.
Study RRS data was collected retrospectively from a 397-bed community hospital in the Midwest; including all adult inpatient RRS events from May 2006 (2 weeks post-RRS implementation) through November 2013. RRS events were analyzed through descriptive, comparative, and proportional odds (ordinal) logistic regression analyses.
The study found the majority of adult inpatient RRS events occurred in medical settings and most were activated by staff nurses. Significant differences were noted between RRS events in medical and surgical settings; including patient status changes in the preceding 12 hours, event trigger patterns, and immediate clinical outcomes. Finally, proportional odds logistic regression revealed significant relationships between context and mechanism factors with changes in the risk of increased clinical severity immediately following at RRS event. RE was utilized to structure a preliminary study to explore the complex variables and relationships surrounding RRSs and patient outcomes. Further exploration of settings, changes in clinical status, staffing and resource access, and the ways nurses use RRSs is necessary to promote the early identification of vulnerable patients and strengthen hospital patient safety strategies.
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Walker, Hattie R. "An analysis of the safety outcome of children in the in-home supervision and out-of-home care." DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 1997. http://digitalcommons.auctr.edu/dissertations/1346.
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The purpose of this study was to compare the safety outcome for children who remained at home under the supervision of the State and children who were placed in foster care. There were two variables: (1) services as the independent variable, and (2) placement outcomes as the dependent variable.
A correlational research design was used to analyze the data. An on-site review instrument was used to collect data from three county Departments of Social Services in South Carolina. Additionally, a case record analysis and a face-to-face interview approach were utilized.
The conclusion drawn from this study is that families are confronted with many stressors and a lack of resources that affect their behavior. The researcher found that in cases where services were provided, maltreated children could remain safely in their homes. For future child maltreatment interventions, this could provide a comprehensive approach to services that might avoid unnecessary out-of-home placements.
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Bonner, Alice F. "Certified Nursing Assistants’ Perceptions of Nursing Home Patient Safety Culture: Is There a Relationship to Clinical or Workforce Outcomes?: A Dissertation." eScholarship@UMMS, 2008. https://escholarship.umassmed.edu/gsn_diss/10.
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Patient safety culture (PSC) is a critical factor in creating high reliability healthcare organizations. However, few studies to date have correlated PSC measures with actual safety outcomes. In particular, nursing home studies have only recently appeared in the literature. Nursing homes differ from hospitals in that the vast majority of direct care is provided by certified nursing assistants (CNAs), not licensed nurses. Thus nursing home PSC could differ in important ways from PSC in acute care institutions.
This dissertation was a secondary data analysis that examined whether CNAs’ perceptions of patient safety culture were correlated with clinical outcomes in a random sample of 74 nursing homes in five randomly selected states. This study matched CNA PSC survey data using the Hospital Survey of Patient Safety Culture (HSOPSC) with Minimum Data Set (MDS), Area Resource File (ARF) and Online Survey Certification and Reporting (OSCAR) data from those same homes during the first two quarters of 2005. In the original study, 1579 nurse aides out of 2872 completed the survey, for a 55% response rate.
In addition to clinical outcomes, this study examined the relationship between CNA PSC scores and staff turnover. The relationship between certain demographic variables, such as level of education, tenure as a CNA, and PSC scores was evaluated. The relationship between certain facility characteristics, such as profit status and bed occupancy was also assessed. An exploratory factor analysis of the original HSOPSC instrument was re-run for this nursing home CNA sample.
Data were analyzed using Poisson regression and multilevel techniques; descriptive statistics were compiled for demographic data. Major findings from the regression analyses and combined GEE models suggest that certain factors, such as CNA turnover and LPN staffing may predict CNA PSC scores. CNA PSC scores were associated with rates of falls and restraint use, but were not associated with differences in pressure ulcer rates in this sample. Few associations for CNA PSC with individual subscales were identified. The exploratory factor analysis revealed some potential differences in how items and subscales factored in this nursing home CNA population.
This dissertation represents an important step in the evaluation of CNA PSC in nursing homes and the relationship of PSC to safety outcomes. Future work on nursing home PSC and clinical and workforce outcomes is described.
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Moore, Darren N. "Mixed Multinomial Logit Analysis of Bicyclist Injury-severity in Single Motor Vehicle Crashes Based on Intersection and Non Intersection Locations." University of Akron / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=akron1247599441.
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DI, BUONO Giuseppe. "SURGICAL INNOVATION IN COLON CANCER: STUDY OF ROLE OF LAPAROSCOPY IN COMPLETE MESOCOLIC EXCISION (CME) FOR RIGHT-SIDED COLON CANCER. FEASIBILITY, SAFETY AND SURGICAL OUTCOME." Doctoral thesis, Università degli Studi di Palermo, 2021. http://hdl.handle.net/10447/508646.
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Honda, Keigo. "Oncologic and sensory functional outcomes of cervical nerve preservation in neck dissection for head and neck cancer." Kyoto University, 2019. http://hdl.handle.net/2433/242890.
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O'Brien, Roxanne Louise. "Keeping patients safe: The relationship between patient safety climate and patient outcomes." Diss., Search in ProQuest Dissertations & Theses. UC Only, 2009. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3378501.
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Bahari, Siti Fatimah binti Binti. "An investigation of safety training, safety climate and safety outcomes : a longitudinal study in a Malaysian manufacturing plant." Thesis, University of Manchester, 2011. https://www.research.manchester.ac.uk/portal/en/theses/an-investigation-of-safety-training-safety-climate-and-safety-outcomes--a-longitudinal-study-in-a-malaysian-manufacturing-plant(904372e7-cd44-4eca-948c-b531adc9e653).html.
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Safety training and safety climate are widely researched topics in the area of safety management. Safety training, as one of the safety interventions, is believed to be an antecedent of safety climate improvement within organisations. The rapid advancement in the safety management field has also raised many questions, mainly regarding the roles of safety training and safety climate within organisations. Recent literature has viewed safety climate as a mediating variable between organisational policies and practices (such as safety training) and safety outcomes. Nevertheless, to date far too few attempts have been made to empirically study the impacts and influence of safety training on safety climate change and to subsequently improve safety outcomes over a period of time, especially in developing countries like Malaysia. To facilitate the expansion of current theoretical perspectives, the research attempts to improve our understanding of safety training's impact on achieving a positive safety culture (via safety climate changes), particularly with regard to improved safety outcomes over a period of time. A quantitative approach, using a longitudinal panel design, was employed for the purpose of data collection. The results were based on two data collections carried out in a Malaysian manufacturing plant in 2008 and 2009. The response rate was 83 percent (N=330) in Time 1, 2008 and 98 percent (N=402) in Time 2, 2009. The findings of this study revealed that there was a significant improvement in all safety training impact subscales indicating that employees' perceived their level of safety knowledge and skill transfer, safe work practices, and their understanding of safety and risk to all be higher in Time 2. The findings of this study also revealed significant improvements in the safety climate dimensions related to Management Attitude and Management Action, indicating that the management role has been viewed as crucial in improving and supporting employees' and organisations' safety. Over a period of time the positive correlation between safety training and safety climate became stronger with a significance difference of .005, where in Time 1, r=.740 and in Time 2, r=.745. This finding adds to the theoretical proposition that safety training is an antecedent to improving safety climate. Similarly, safety outcomes have significantly improved over a period of time and have a negative correlation with safety training and safety climate. Overall, the current study has gone some way towards enhancing our understanding of safety training impacts and its influence on safety climate, particularly with regard to the improvement of safety outcomes. However, this study has thrown up a number of questions that are in need of further investigation. The need for further research to investigate the effectiveness of specific safety training intervention with the addition of motivational factors, and its relation to safety climate over a period of time in various industries, remain crucial.
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Wilson, Katherine Ann. "Does safety culture predict clinical outcomes?" Doctoral diss., University of Central Florida, 2007. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/2919.
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Patient safety in healthcare has become a national objective. Healthcare organizations are striving to improve patient safety and have turned to high reliability organizations as those in which to model. One initiative taken on by healthcare is improving patient safety culture--shifting from one of a 'no harm, no foul' to a culture of learning that encourages the reporting of errors, even those in which patient harm does not occur. Lacking from the literature, however, is an understanding of how safety culture impacts outcomes. While there has been some research done in this area, and safety culture is argued to have an impact, the findings are not very diagnostic. In other words, safety culture has been studied such that an overall safety culture rating is provided and it is shown that a positive safety culture improves outcomes. However, this method does little to tell an organization what aspects of safety culture impact outcomes. Therefore, this dissertation sought to answer that question but analyzing safety culture from multiple dimensions. The results found as a part of this effort support previous work in other domains suggesting that hospital management and supervisor support does lead to improved perceptions of safety. The link between this support and outcomes, such as incidents and incident reporting, is more difficult to determine. The data suggests that employees are willing to report errors when they occur, but the low occurrence of such reportable events in healthcare precludes them from doing so. When a closer look was taken at the type of incidents that were reported, a positive relationship was found between support for patient safety and medication incidents. These results initially seem counterintuitive. To suggest a positive relationship between safety culture and medication incidents on the surface detracts from the research in other domains suggesting the opposite. It could be the case that an increase in incidents leads an organization to implement additional patient safety efforts, and therefore employees perceive a more positive safety culture. Clearly more research is needed in this area. Suggestions for future research and practical implications of this study are provided.Ph.D.
Department of Psychology
Sciences
Psychology PhD
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Sibiya, Lihle. "The effect of transformational and transactional leadership, safety culture on safety outcomes." Diss., University of Pretoria, 2015. http://hdl.handle.net/2263/52319.
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Leaders are organisational architects with an ability to influence the inputs and outputs
of business performance which includes safety performance. Inputs and outputs in the
context of this study include the safe behaviour of employees and the leader s role in
creating a safe working environment. Studies in safety leadership have shown that
transformational leadership results in high employee safety participation whereas
transactional leadership results in increased safety compliance. Recent studies have
focused mainly on the impact of the two leadership styles on the safety climate. This
study aims to bridge the existing gap in understanding the effect of transformational,
transactional leadership and safety culture on safety outcomes. Self-administered and
online questionnaires were used to collect data in chemical organisations in Durban.
The number of returned valid questionnaires was 250. Analysis included various
correlation tests and multiple regression analysis to test the relationships between the
three variables. Results revealed that transformational and transactional leadership
lead to different safety outcomes. In addition, transactional leadership positively
impacts on safety culture when compared with transformational leadership which has
demonstrated a negative relationship.Mini Dissertation (MBA)--University of Pretoria, 2015.
sn2016
Gordon Institute of Business Science (GIBS)
MBA
Unrestricted
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Januel, Jean-Marie. "Les données de routine des séjours d’hospitalisation pour évaluer la sécurité des patients : études de la qualité des données et perspectives de validation d’indicateurs de la sécurité des patients." Thesis, Lyon 1, 2011. http://www.theses.fr/2011LYO10355/document.
Full textAbstract:
Évaluer la sécurité des patients hospitalisés constitue un enjeu majeur de la gestion des risques pour les services de santé. Le développement d’indicateurs destinés à mesurer les événements indésirables liés aux soins (EIS) est une étape cruciale dont le défi principal repose sur la performance des données utilisées. Le développement d’indicateurs de la sécurité des patients – les Patient Safety Indicators (PSIs) – par l’Agency for Healthcare Research and Quality (AHRQ) aux Etats Unis, utilisant des codes de la 9ème révision (cliniquement modifiée) de la Classification Internationale des Maladies (CIM) présente des perspectives intéressantes. Nos travaux ont abordé cinq questions fondamentales liées au développement de ces indicateurs : la définition du cadre nosologique, la faisabilité de calcul des algorithmes et leur validité, la qualité des données pour coder les diagnostics médicaux à partir de la CIM et leur performance pour comparer plusieurs pays, et la possibilité d’établir une valeur de référence pour comparer ces indicateurs. Certaines questions demeurent cependant et nous proposons des pistes de recherche pour améliorer les PSIs : une meilleure définition des algorithmes et l’utilisation d’autres sources de données pour les valider (i.e., données de registre), ainsi que l’utilisation de modèles d’ajustement utilisant l’index de Charlson, le nombre moyen de diagnostics codés et une variable de la valeur prédictive positive, afin de contrôler les variations du case-mix et les différences de qualité du codage entre hôpitaux et paysAssessing safety among hospitalized patients is a major issue for health services. The development of indicators to measure adverse events related to health care (HAE) is a crucial step, for which the main challenge lies on the performance of the data used for this approach. Based on the limitations of the measurement in terms of reproducibility and on the high cost of studies conducted using medical records audit, the development of Patient Safety Indicators (PSI) by the Agency for Healthcare Research and Quality (AHRQ) in the United States, using codes from the clinically modified 9th revision of the International Classification of Diseases (ICD) shows interesting prospects. Our work addressed five key issues related to the development of these indicators: nosological definition; feasibility and validity of codes based algorithms; quality of medical diagnoses coding using ICD codes, comparability across countries; and possibility of establishing a benchmark to compare these indicators. Some questions remain, and we suggest several research pathways regarding possible improvements of PSI based on a better definition of PSI algorithms and the use of other data sources to validate PSI (i.e., registry data). Thus, the use of adjustment models including the Charlson index, the average number of diagnoses coded and a variable of the positive predictive value should be considered to control the case-mix variations and differences of quality of coding for comparisons between hospitals or countries
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Heritage, Kyle M. "Lagged relationships between a multilevel model of safety climate and employee safety outcomes." Thesis, Curtin University, 2012. http://hdl.handle.net/20.500.11937/858.
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In Zohar’s Multilevel Model of Safety Climate (Zohar, 2000; 2003; Zohar & Luria, 2005), workers’ perceptions of their supervisor and manager’s commitment to safety are separately assessed and aggregated to the group and organisational level respectively. Treating safety climate as a multilevel construct has a number of conceptual and methodological advantages over the traditional single-level approach; however few researchers have adopted this practice and examined the cross-level or the lagged effects of safety climate.In the current thesis, the cross-level and lagged relationships safety climate has with safety outcomes was investigated through the use of a recently developed multilevel safety climate survey in the Australian oil and gas context. Data was collected over a two year period in a single organisation. The survey consisted of three scales, separately examining manager, supervisor, and co-worker commitment to safety. Safety outcomes were operationalized as self-reported near misses and injuries.The assessment of cross-level and lagged relationships involved a number of analyses, distributed across five objectives. In Objective One the factorial validity of the scales was assessed using confirmatory factor analysis. In Objective Two the cross-sectional criterion validity of the scales was examined using multilevel logistic regression in order to determine whether commitment to safety at each level of the organisation was associated with safety outcomes. In Objective Three, the predictive validity of each scale was assessed using multilevel Poisson regression in order to determine whether safety climate scores in Year One were predictive of safety outcomes in Year Two. In Objective Four, a series of path models were compared using path analysis in order to examine cross-level relationships between manager, supervisor, and co-worker commitment to safety. This analysis allowed the replication of Zohar and Luria’s (2005) findings, and could determine whether Zohar’s model could be extended to include perceptions of co-workers. In Objective Five, comparisons were made between safety climate operationalized at the individual and aggregate level, given the inconsistent labelling of safety climate at both levels of analysis despite the possibility that they may be distinct constructs.While all three scales demonstrated acceptable factorial validity, only the supervisor and manager scales provided evidence of criterion and predictive validity through significant associations with self-reported near misses. Path model comparisons provided support for Zohar’s Multilevel Model of Safety Climate and further suggested that co-workers were of lesser importance in promoting safety compared to supervisors and managers.Comparisons between safety climate operationalized at the individual and aggregate level demonstrated that level of analysis did affect that pattern of relationships between safety climate and self-reported near misses. While aggregated co-worker safety climate was the weakest predictor of self-reported near misses, individual level co-worker safety climate was the strongest predictor even after controlling for higher level variance. Analyses further indicated that individual level co-worker safety climate mediated the relationship between aggregated supervisor safety climate and individual level self-reported near misses.While replication of these findings is necessary, the results overall supported Zohar’s Multilevel Model of Safety Climate and suggested that the model could be extended to include individual level perceptions of co-workers. Results also indicated that level-of-analysis has a potentially important effect on the pattern of relationships between safety climate and safety outcomes.
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Thornlow, Deirdre. "Relationship of patient safety practices to patient outcomes." Saarbrücken VDM Verlag Dr. Müller, 2007. http://d-nb.info/991198212/04.
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Taylor, Veronica. "Needle Guide Efficacy and Safety in Pediatric Renal Biopsies." University of Cincinnati / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1563527742490046.
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White, Codi. "Interpersonal Safety Skills: Assessing and Evaluating Outcomes for Children." Thesis, Griffith University, 2017. http://hdl.handle.net/10072/371212.
Full textAbstract:
The safety of children is a priority within society. Programs have been created to
boost young children’s interpersonal safety skills, including teaching children how to
recognise and avoid risky situations and when to disclose to safe adults. However,
behavioural outcomes of these programs have rarely been evaluated, so general
knowledge about children’s use of these skills following program participation remains
limited. Few standardised measures exist to assess these behavioural outcomes of risk
avoidance or disclosure. To fill this gap, a new measure of children’s interpersonal
safety skills, the Observed Protective Behaviours Test (OPBT), was developed and three
studies were conducted that used the OPBT. The OPBT included a simulated lure that
assessed children's motor and verbal responses to the lure, as well as their disclosure.
In Study 1, 611 children in Year 1 (5 to 7 years; 50% male), attending schools
either allocated to receive Learn to be safe with Emmy and friendsTM or on a waitlist,
completed three assessments over seven months. Children were individually
interviewed at each assessment and parents completed surveys at home. When
compared to waitlist, the program was effective in improving interpersonal safety
knowledge (child and parent-rated) and parent-rated interpersonal safety skills from preto
post-program. At a 6-month follow-up improvements were retained, with children
who participated in the program also reporting increased disclosure confidence
compared to children on the waitlist. However, improvements in intentions to disclose
and safety identification skills, as well as interpersonal safety skills as measured by the
OPBT, did not differ between program and waitlist conditions.
In Study 2, the participants were 281 children who were assessed as part of
Study 1. Two strata of children, those in Learn to be safe with Emmy and friendsTM or
on a waitlist, were randomly assigned to participate in the OPBT (i.e., an in-situ training; IST) or not. Thus, four groups were compared: Waitlist, IST alone, Program
alone, and Program+IST. All children completed two assessments separated by seven
months. The IST was found to produce improvements, with children in the IST alone
condition showing a greater increase in intentions to disclose compared to Waitlist, and
children who participated in Program+IST showing greater improvements in disclosure
intentions than those who received Program only or Waitlist, as well as displaying
significantly greater increases in disclosure confidence compared to children who
received Waitlist.
In Study 3, the participants were 118 children who had participated in the OPBT
without any other intervention component in Study 1. Prevalence of interpersonal safety
skills as measured by the OPBT (withdrawal from an unknown confederate, verbal
refusal of an abduction lure and disclosure of confederate presence) were summarised,
and correlates of OPBT responses were examined. In total, 27% children withdrew from
the confederate, 48% refused the lure and 83% disclosed the presence of the
confederate. The only significant correlate of these skills was anxiety, with children who
had greater anxiety disclosing earlier and being more likely to accept the lure.
Overall, findings provide new information regarding training and correlates of
interpersonal safety skills in young children. The Learn to be safe with Emmy and
friendsTM program was effective in increasing safety knowledge, parent-rated safety
knowledge and skills, and disclosure confidence. Further, using the OPBT as an IST
resulted in greater increases in children's intentions to disclose and confidence in
disclosure. However, whilst great variability was found in children’s use of
interpersonal safety skills as measured by the OPBT, the only significant predictor
found for these skills was anxiety. Several avenues for further research are suggested,
including examining further predictors for interpersonal safety skills, expanding the OPBT to represent more interpersonal situations, evaluating the effectiveness of booster
IST components on other interpersonal safety programs and expanding the age range of
children examined.Thesis (PhD Doctorate)
Doctor of Philosophy in Clinical Psychology (PhD ClinPsych)
School of Applied Psychology
Griffith Health
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Fischer, Shira H. "Factors Associated with Ordering and Completion of Laboratory Monitoring Tests for High-Risk Medications in the Ambulatory Setting: A Dissertation." eScholarship@UMMS, 2011. https://escholarship.umassmed.edu/gsbs_diss/543.
Full textAbstract:
Since the Institute of Medicine highlighted the devastating impact of medical errors in their seminal report, “To Err is Human” (2000), efforts have been underway to improve patient safety. A portion of medical errors are due to medication errors, and a large portion of these can be attributed to inadequate laboratory monitoring.
In this thesis, I attempt to address this small but important corner of this patient safety endeavor. Why are patients not getting their laboratory monitoring tests? Do they fail to complete them or do doctors not order the tests in the first place? Which prescribers and which patients are least likely to do what is needed for testing to happen and what interventions would be most promising?
To address these questions, I conducted a systematic review of existing interventions. I then proceeded with three aims: 1) To identify reasons that patients give for missing monitoring tests; 2) To identify patient and provider factors associated with monitoring test ordering; and 3) To identify patient and provider factors associated with completion of ordered testing.
To achieve these aims, I worked with patients and data at the Fallon Clinic. For aim 1, I conducted a qualitative analysis of their reasons for missing tests as well as reporting completion and ordering rates. For aims 2 and 3, I used electronic medical record data and conducted a regression with patient and provider characteristics as covariates to identify factors contributing to test ordering and completion.
Interviews revealed that patients had few barriers to completion, with forgetting being the most common reason for missing a test. The quantitative studies showed that: older patients with more interactions with the health care system were more likely to have tests ordered and were more likely to complete them; providers who more frequently prescribe a drug were more likely to order testing for it; and drug-test combinations that were particularly dangerous, indicated by a black box warning, were more likely to have appropriate ordering, though for these combinations, primary care providers were less likely to order tests appropriately, and patients were less likely to complete tests.
Taken together, my work can inform future interventions in laboratory monitoring and patient safety.
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Root, Scott. "Investigating Corrective Instructional Activities for Secondary-Level Students Within Mastery Learning Environments." Thesis, NSUWorks, 2015. https://nsuworks.nova.edu/fse_etd/34.
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This applied dissertation was designed to provide a better understanding of the effectiveness of out-of-class safety net corrective instructional activity practices conducted beyond regular classroom instruction for lower secondary level (9th- and 10th- grade high school) students within mastery learning educational environments. The study was designed to shed light on the impact and implications of these practices on Bloom’s vanishing point (Bloom, 1971) and Arlin’s leveling effect (Arlin & Westbury, 1976). Seven mastery learning structured international schools in geographic proximity, of similar size, and utilizing the same program of study were used in this study. Three of the schools that employed a safety net program were the basis of this study, and the four schools that did not have in place a safety net program were used as a control for this observational research.
Normed Measures of Academic Progress (MAP) RIT scores (Northwest Evaluation Association, 2005), grade point averages, and safety net program data were used in a series of case-control tests to determine the effectiveness of out-of-class corrective instructional activity safety net programs for above-average and below-average achieving students. The mean study and control group RIT percentile ranking scores for the students was nearly 1 standard deviation above the averages reported by the Northwest Evaluation Association (2005), so these relative comparisons involved bright students. This large volume of data enabled analysis of the effects of out-of-class safety net activities on school-wide and individual improvement in literature, writing, mathematics, and comprehensive results.
Series of conclusive nonparametric analysis were used instead of normal distribution tests because of the out-of-bounds skewed nature of the data. Analysis of the data suggested that safety netting programs benefit all students, irrespective of whether or not students received out-of-class corrective instructional activities. The MAP RIT scores of below- average achieving students were not affected by attending a school with a safety net program but their GPA results improved in all subjects. Arlin’s leveling effect (Arlin & Westbury, 1976) most likely accounted for improvement of MAP RIT scores for above- average students who attended a school with a safety net program but their GPA results were not affected. These contrasting benefits masked the school-wide test results, which suggested that a school district might not realize an overall increase in MAP RIT and GPA results when adopting a safety net program. Students identified in need of safety netting services benefited by having been placed in the program up to twice in any respective course, but a point of diminishing returns was reached when a student fell 3 or more units behind in a course in relation to the progress of the class.
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Paez, Omar. "Financial Assessment of Health and Safety Programs in the Workplace." University of Cincinnati / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1383909213.
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Healy, Christine. "Influence of Psychological Empowerment, Leadership, and Climate on Safety Outcomes." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4449.
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Research has demonstrated that safety outcomes are impacted by workplace risk factors, but also supervisory practices and employee actions. An area that has not been explored is the impact of employee cognitions on safety outcomes defined as work-related injuries. Based on the conceptual framework of psychological empowerment (PE), the purpose of this study was to examine the relationship of employee cognitions as measured by PE as related to leadership and safety climate and the occurrence of work-related injury. The research examined the mediating effect of (PE) on the factors of leadership and safety climate and their relationship to work-related injury. A cross-sectional survey design was used to gather data from a convenience sample of 125 front-line food manufacturing employees from 3 different organizations. Multiple regression was used to analyze data from the Organization-Level Safety Climate Scale, the Psychological Empowerment Instrument, the Leader Behavior Scale, and number of self-reported injuries. The results of the analysis were non-significant. Although the results were non-significant, this study promotes positive social change in bringing awareness to the issue of employee cognitions and their role in workplace injury. Exploring the implications of cognitive variables including PE using a different methodology such as incorporating a qualitative follow-up questionnaire could lead to clarity of the value of PE in reducing workplace injury thereby positively impacting employees, organizations, family members, and tax payers.
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Soro, Wonmongo Lacina. "Towards an understanding of financial influences on heavy vehicle safety outcomes." Thesis, Queensland University of Technology, 2020. https://eprints.qut.edu.au/205596/1/Wonmongo%20Lacina_Soro_Thesis.pdf.
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This thesis sought to better understand how financial pressures influence the safety of heavy truck operations in Australia. Truck driver employment (direct and outsourced) and payment methods influenced the risk of crashes and unsafe driving behaviours, and were in turn associated with companies’ perceptions of their financial performance. Improved training in financial management and monitoring of financial performance could be effective approaches to improving safety of both freight transport and those who share the roads with heavy trucks.
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Al, Haadir Saeed Ali. "Model for Improving Safety Behaviours and Outcomes in the Saudi Arabian Construction Industry." Thesis, Griffith University, 2015. http://hdl.handle.net/10072/366330.
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Construction workplace safety has always been a main concern within the construction industry. Statistics on accidents and injuries generally place the construction sector as one of most hazardous sectors, principally in developing countries. Although a lot of improvement in construction workplace safety has been accomplished, the construction industry still lags behind the majority of other industries with regard to safety. Safety rules in developing countries often do not exist and the regulatory authority is generally not strong in implementing such rules efficiently. Additionally, work hazards on construction sites are either perceived to be less dangerous than what they in reality are, or are not perceived at all.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
Griffith School of Engineering
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Hartz, Wayne Edward. "21st-Century U.S. Safety Professional Educational Standards: Establishing Minimum Baccalaureate Graduate Learning Outcomes for Emerging Occupational Health and Safety Professionals." Antioch University / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1387378108.
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Wynn, Gareth. "Improving ablation outcomes in atrial fibrillation : improving procedural efficacy, safety, and patient selection." Thesis, Imperial College London, 2015. http://hdl.handle.net/10044/1/29109.
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Atrial fibrillation (AF) is a major health problem, affecting 1-2% of the population. AF reduces quality of life (QoL) and increases morbidity and mortality. Catheter ablation (CA) is the most efficacious means of restoring sinus rhythm but is not always successful and is occasionally associated with serious complications. Several questions are currently unanswered. True procedural effectiveness, particularly long-term, remains uncertain, especially in more advanced disease. The best technique for achieving success remains an issue of considerable debate and as yet, few, if any, means exist to predict when acute electrical success will translate into sustained clinical benefit. CA is indicated for symptomatic relief but QoL, both as a treatment outcome and as a guide to patient selection, has generally been overlooked in the published literature. Finally, although the maxim, 'First, do no harm' may often be ascribed erroneously to Hippocrates, it remains a central tenet of medical practice. However, little previous research has focussed on improving the safety of CA. I have attempted to tackle these issues from a number of angles. I have performed a comprehensive literature review and a retrospective analysis of ablation outcomes at Liverpool Heart and Chest Hospital, the largest and longest such data from the UK, to ascertain a comprehensive, up-to-date assessment of practice. In an effort to improve procedural success, I carried out a multicentre randomised controlled trial testing two ablation strategies. A sub-study tests the hypothesis that clinical outcomes can be predicted by a novel measure of effective ablation. Two further studies aim to improve safety, through use of ultrasound to guide venous access, and to better understand QoL in AF - a theme throughout the thesis - which may help improve selection of appropriate patients for CA. Together, I hope these studies will help physicians improve the outcomes of CA for their patients.
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Ellison, Adrian Bachman. "Evaluating changes in driver behaviour for road safety outcomes: a risk profiling approach." Thesis, The University of Sydney, 2013. http://hdl.handle.net/2123/11567.
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Road safety continues to be an important issue with road crashes among the leading causes of death. Considerable effort has been put into improving our understanding of the factors that influence driving behaviour with a view to devising more effective road safety strategies. Within the literature, demographics, social norms, personality, enforcement and the road environment have all been identified as influencers of risky driving behaviour. What is missing is an integrated empirical approach which examines the relationship between these factors and drivers’ awareness of their speeding behaviour to a measure of day-to-day driving behaviour. This research employs demographic, psychological, vehicle, trip and Global Positioning System (GPS) driving data collected from 106 drivers in Sydney, Australia during a pay-as-you-drive study. The main contributions are three-fold. First, a methodology is developed to control for the influence of spatiotemporal characteristics on driver behaviour. This deals with the inherent variability introduced from road environment factors external to the driver which would otherwise lead to misleading results. Second, the creation of a composite measure of driver behaviour allows driver behaviour to be described using a single measure whilst accounting for the variability and multitude of aspects within the driving task. This allows drivers to be compared to each other and for the same driver to be compared across time and space permitting empirical testing of interventions in a before and after study. Lastly, this research reveals the potential for reducing the extent and magnitude of risky driving behaviour by making drivers aware of their own behaviour. The results indicate that drivers can be placed in three groups: drivers requiring a monetary incentive to change speeding behaviour, drivers requiring information alone to change their speeding behaviour and drivers that appear unresponsive to both monetary incentives and information.
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Perrier, Marie-Josée. "Understanding driving after stroke: safety outcomes and characteristics of those who return to driving." Thesis, McGill University, 2009. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=66994.
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It is difficult to assess driving safety according to stroke sequelae, given that little attention has been given to the characteristics of post-stroke drivers. Therefore, the specific objective was to estimate the extent to which neurological and functional factors at 3 months predict driving resumption at 12 months post-stroke. A sub-cohort of drivers (n=290) were sampled from 678 Canadians who were participating in a longitudinal study of stroke outcomes. Of 290 participants (68% men; age: 64 years; CNS: 8.5), 177 (61%) returned to driving at one year. The relationships between the factors influencing driving status were modeled in a path analysis. Persons with higher scores on the combined SIS scales for strength and activity and MMSE, as well as those with ischemic stroke, will be more likely to return to driving. Fatigue, gender and stroke severity indirectly influence driving through strength and activity. Gender differences were also found in the level of fatigue. Future work that carefully incorporates more sensitive measures of function in a path model with contextual factors will confirm these results.Peu d'attention a été portée sur les caractéristiques des conducteurs suite à un ACV, alors il est très difficile de prendre en considération les risques d'accident associés aux séquelles d'un ACV. Par conséquent, l'objectif spécifique était d'estimer à quel point les facteurs neuraux et fonctionnels à 3 mois prédisent un retour à la conduite 12 mois suite à un ACV. Une sous-cohorte de conducteurs (n=290) a été sélectionnée de 678 canadiens qui ont participé à une étude longitudinale portant sur les variables reliés à un ACV. Des 290 participants (68% sont des hommes, âge 64 ans, CNS : 8.5), 177 (61%) reconduisaient après 12 mois. La relation entre les facteurs et le statut de conduite ont été modelé afin de faire une analyse des pistes causales (path analysis). Les personnes présentant un score élevé sur l'échelle SIS pour la force et l'activité combiné au MMSE, ainsi que les personnes ayant un ACV ischémique, sont plus enclin de conduire de nouveau. La fatigue, le genre ainsi que la sévérité de l'ACV influencent indirectement la conduite à travers force et l'activité. Les futures recherches intégrant des mesures plus sensibles. La prochaine direction à prendre est d'intégrer des mesures de la fonction plus sensible à l'analyse des causalités avec des facteurs contextuels.
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Burström, Lena. "Patient Safety in the Emergency Department : Culture, Waiting, and Outcomes of Efficiency and Quality." Doctoral thesis, Uppsala universitet, Institutionen för kirurgiska vetenskaper, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-223987.
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The overall aim of this thesis was to investigate patient safety in the emergency department (ED) and to determine whether this varies according to patient safety culture, waiting, and outcomes of efficiency and quality variables. I: Patient safety culture was described in the EDs of two different hospitals before and after a quality improvement project. The questionnaire “Hospital Survey on Patient Safety Culture” was used to investigate the patient safety culture. The main finding was that the staff at both hospitals scored more positively in the dimension Team-work within hospital after implementing a new work model aimed at improving patient flow and patient safety in the ED. Otherwise, we found only modest improvements. II: Grounded theory was used to explore what happens in the ED from the staff perspective. Their main concern was reducing patients’ non-acceptable waiting time. Management of waiting was improved either by increasing the throughput of patient flow by structure pushing and by shuffling patients, or by changing the experience of waiting by calming patients and by feinting to cover up. III: Three Swedish EDs with different triage models were compared in terms of efficiency and quality. The median length of stay was 158 minutes for physician-led team triage compared with 243 and 197 minutes for nurse–emergency physician and nurse–junior physician triage, respectively. Quality indicators (i.e., patients leaving before treatment was completed, the rate of unscheduled return within 24 and 72 hours, and mortality rate within 7 and 30 days) improved under the physician-led team triage. IV: Efficiency and quality variables were compared from before (2008) to after (2012) a reorganization with a shift of triage model at a single ED. Time from registration to physician decreased by 47 minutes, and the length of stay decreased by 34 minutes. Several quality measures differed between the two years, in favour of 2012. Patients leaving before treatment was completed, unscheduled return within 24 and 72 hours, and mortality rate within 7 and 30 days all improved despite the reduced admission rate. In conclusion, the studies underscore the need to improve patient safety in the ED. It is important to the patient safety culture to reduce patient waiting because it dynamically affects both patients and staff. Physician-led team triage may be a suitable model for reducing patient waiting time and increasing patient safety.
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Maddocks, Jordan Scott. "Trends in Adherence and Patient Outcomes in a Safety Net Medication Therapy Management Program." University of Toledo Honors Theses / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=uthonors1309357633.
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Parker, Ian. "Does facial physiognomy in the context of anoccupational safety and health message predict outcomes?" Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2018. https://ro.ecu.edu.au/theses/2124.
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Physiognomy, the practice of looking to another person’s outward facial appearance to unmask the inner character of that person, has had a diverse historical impact within art, medicine, theology, anthropology, law, criminology, political history, psychology, psychiatry, and popular culture, since it was conceptualised in Greece during the 5th and 4th centuries B.C (Physiognomy, 1999-2009, 2009a). Aristotle, the prominent Greek philosopher, penned many chapters on physiognomic properties and touched upon strength/weakness, genius/stupidity, and other trait characteristics and their opposites in so far as such characteristics were associated with facial form (Physiognomy, 2006, 2009b).
In more modern times, facial recognition and evaluation of faces is seen as a function of evolution that has significance with regard to approach/avoidance behaviour (Oosterhof & Todorov, 2008). These authors found that evaluation of emotionally neutral faces can be explained by judgements of two traits, facial trustworthiness and facial dominance, and that these traits can be related to the facial expressions for happy and angry, respectively. Evidence from advertising, psychological, and neurobiological experiments show that facial physiognomy, the concept that a person’s character can be revealed from their facial features, influences cognitive and emotional judgements. The belief is that people possess the ability to read the character of another person from facial expressions and facial appearance. People make trait judgements based on facial physiognomy (Highfield, Wiseman, & Jenkins, 2009). The exploration of facial physiognomy is an ever increasing endeavour, particularly when people make social judgements to infer another person’s ability to harm or the ability to cause harm (Oosterhof & Toderov, 2009; Oosterhof & Todorov, 2008).
In this mixed method study, computer software was used to morph the facial physiognomy of an endorser, actor, model or spokesperson as shown in the context of an occupational safety and health promotional message. This study endeavoured to establish to what extent facial presentation, and the evaluation thereof, influences the effectiveness of health promotional images. Five versions of facial physiognomy were explored along trustworthy/untrustworthy and dominant/passive dimensions. The advertising believability scale was utilised as a primary measure of advertisement validity (Beltramini, 1988). For comparison purposes Ohanian’s (1990) source-credibility scale for evaluating endorser attractiveness, trustworthiness, and expertise was also utilised as a measuring instrument. Endorser dominance was measured with the perceived dominance scale (Manusov, 2005). Qualitative data was collected using semi-structured in-depth interviews to analyse the process of endorser selection. Transcribed interviews were coded and thematically analysed. These data were considered particularly useful to inform the creative strategy of marketing professionals in the development of visual domain advertising. Quantitative data was collected with the aid of a structured questionnaire designed to measure recall of a safety message, agreement with the message, the likelihood of practicing the behaviours presented in the message, and belief of the information presented in the message. Quantitative data were analysed utilising descriptive statistics, advanced parametric statistics, tables, figures and graphs. Data from both qualitative and quantitative sources were compared and interpreted as a whole; juxtaposed against underlying theory. This study contributes new knowledge to occupational safety and health promotion by examining endorser facial graphics in creative artwork and gauging messages effectiveness in light of the facial representation. The research has utility for academics, advertising, marketing, health promotion, and occupational safety and health practitioners involved in the development of promotional materials through evidence-based practices, endorser selection, image enhancement, and advertising awareness. An original and significant contribution will be made to the occupational safety and health literature.
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Blackman, Ross Alexander. "The increased popularity of mopeds and motor scooters : exploring usage patterns and safety outcomes." Thesis, Queensland University of Technology, 2012. https://eprints.qut.edu.au/52685/1/Ross_Blackman_Thesis.pdf.
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Increased use of powered two-wheelers (PTWs) often underlies increases in the number of reported crashes, promoting research into PTW safety. PTW riders are overrepresented in crash and injury statistics relative to exposure and, as such, are considered vulnerable road users. PTW use has increased substantially over the last decade in many developed countries. One such country is Australia, where moped and scooter use has increased at a faster rate than motorcycle use in recent years. Increased moped use is particularly evident in the State of Queensland which is one of four Australian jurisdictions where moped riding is permitted for car licence holders and a motorcycle licence is not required.
A moped is commonly a small motor scooter and is limited to a maximum design speed of 50 km/h and a maximum engine cylinder capacity of 50 cubic centimetres. Scooters exceeding either of these specifications are classed as motorcycles in all Australian jurisdictions.
While an extensive body of knowledge exists on motorcycle safety, some of which is relevant to moped and scooter safety, the latter PTW types have received comparatively little focused research attention. Much of the research on moped safety to date has been conducted in Europe where they have been popular since the mid 20th century, while some studies have also been conducted in the United States. This research is of limited relevance to Australia due to socio-cultural, economic, regulatory and environmental differences. Moreover, while some studies have compared motorcycles to mopeds in terms of safety, no research to date has specifically examined the differences and similarities between mopeds and larger scooters, or between larger scooters and motorcycles.
To address the need for a better understanding of moped and scooter use and safety, the current program of research involved three complementary studies designed to achieve the following aims: (1) develop better knowledge and understanding of moped and scooter usage trends and patterns; and (2) determine the factors leading to differences in moped, scooter and motorcycle safety.
Study 1 involved six-monthly observations of PTW types in inner city parking areas of Queensland’s capital city, Brisbane, to monitor and quantify the types of PTW in use over a two year period. Study 2 involved an analysis of Queensland PTW crash and registration data, primarily comparing the police-reported crash involvement of mopeds, scooters and motorcycles over a five year period (N = 7,347). Study 3 employed both qualitative and quantitative methods to examine moped and scooter usage in two components: (a) four focus group discussions with Brisbane-based Queensland moped and scooter riders (N = 23); and (b) a state-wide survey of Queensland moped and scooter riders (N = 192).
Study 1 found that of the PTW types parked in inner city Brisbane over the study period (N = 2,642), more than one third (36.1%) were mopeds or larger scooters. The number of PTWs observed increased at each six-monthly phase, but there were no significant changes in the proportions of PTW types observed across study phases. There were no significant differences in the proportions or numbers of PTW type observed by season.
Study 2 revealed some important differences between mopeds, scooters and motorcycles in terms of safety and usage through analysis of crash and registration data. All Queensland PTW registrations doubled between 2001 and 2009, but there was an almost fifteen-fold increase in moped registrations. Mopeds subsequently increased as a proportion of Queensland registered PTWs from 1.2 percent to 8.8 percent over this nine year period. Moped and scooter crashes increased at a faster rate than motorcycle crashes over the five year study period from July 2003 to June 2008, reflecting their relatively greater increased usage. Crash rates per 10,000 registrations for the study period were only slightly higher for mopeds (133.4) than for motorcycles and scooters combined (124.8), but estimated crash rates per million vehicle kilometres travelled were higher for mopeds (6.3) than motorcycles and scooters (1.7). While the number of crashes increased for each PTW type over the study period, the rate of crashes per 10,000 registrations declined by 40 percent for mopeds compared with 22 percent for motorcycles and scooters combined.
Moped and scooter crashes were generally less severe than motorcycle crashes and this was related to the particular crash characteristics of the PTW types rather than to the PTW types themselves. Compared to motorcycle and moped crashes, scooter crashes were less likely to be single vehicle crashes, to involve a speeding or impaired rider, to involve poor road conditions, or to be attributed to rider error. Scooter and moped crashes were more likely than motorcycle crashes to occur on weekdays, in lower speed zones and at intersections. Scooter riders were older on average (39) than moped (32) and motorcycle (35) riders, while moped riders were more likely to be female (36%) than scooter (22%) or motorcycle riders (7%). The licence characteristics of scooter and motorcycle riders were similar, with moped riders more likely to be licensed outside of Queensland and less likely to hold a full or open licence. The PTW type could not be identified in 15 percent of all cases, indicating a need for more complete recording of vehicle details in the registration data.
The focus groups in Study 3a and the survey in Study 3b suggested that moped and scooter riders are a heterogeneous population in terms of demographic characteristics, riding experience, and knowledge and attitudes regarding safety and risk. The self-reported crash involvement of Study 3b respondents suggests that most moped and scooter crashes result in no injury or minor injury and are not reported to police. Study 3 provided some explanation for differences observed in Study 2 between mopeds and scooters in terms of crash involvement. On the whole, scooter riders were older, more experienced, more likely to have undertaken rider training and to value rider training programs. Scooter riders were also more likely to use protective clothing and to seek out safety-related information.
This research has some important practical implications regarding moped and scooter use and safety. While mopeds and scooters are generally similar in terms of usage, and their usage has increased, scooter riders appear to be safer than moped riders due to some combination of superior skills and safer riding behaviour. It is reasonable to expect that mopeds and scooters will remain popular in Queensland in future and that their usage may further increase, along with that of motorcycles. Future policy and planning should consider potential options for encouraging moped riders to acquire better riding skills and greater safety awareness. While rider training and licensing appears an obvious potential countermeasure, the effectiveness of rider training has not been established and other options should also be strongly considered. Such options might include rider education and safety promotion, while interventions could also target other road users and urban infrastructure.
Future research is warranted in regard to moped and scooter safety, particularly where the use of those PTWs has increased substantially from low levels. Research could address areas such as rider training and licensing (including program evaluations), the need for more detailed and reliable data (particularly crash and exposure data), protective clothing use, risks associated with lane splitting and filtering, and tourist use of mopeds. Some of this research would likely be relevant to motorcycle use and safety, as well as that of mopeds and scooters.
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ROTOLO, Stefano. "Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) for Unresectable Peritoneal Metastases. Feasibility, Safety and Efficacy Outcomes." Doctoral thesis, Università degli Studi di Palermo, 2022. http://hdl.handle.net/10447/534813.
Full textAbstract:
Recently, a novel method for chemotherapy administration inside the abdominal cavity gained wide attention among surgical oncologists dealing with peritoneal surface malignancies. Based on laparoscopy, Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) is a drug delivery system designed to overcome the known hurdles of intraperitoneal chemotherapy. Preclinical data suggest that the aerosol drug that PIPAC creates and the increased intraabdominal pressure obtained during laparoscopy provide highly effective distribution of cytotoxic compounds into tumor nodules. Several studies have documented the favorable safety profile and promising clinical outcomes of repetitive PIPAC in different types of peritoneal malignancies.
The present research assessed the feasibility, safety, and antitumor activity of current PIPAC drug treatment schedules through a systematic review of the literature and two retrospective cohort studies on gastric cancer and pancreatic or biliary tract cancer. In addition, it includes the study protocol of the first phase II trial exploring nabpaclitaxel PIPAC in combination with gemcitabine/nabpaclitaxel systemic chemotherapy.
The systematic review of the literature of 668 patients showed an overall pathological response rate of 44% and a severe adverse events rate of 10%.
In the single-center cohort of 28 consecutive patients affected by gastric cancer peritoneal metastases undergoing cisplatin/doxorubicin PIPAC and systemic chemotherapy, the pathological response rate, in the Intention-to Treat population, was 29%, with a 7% rate of severe adverse events and 1.7 PIPAC procedures per patient.
In the 20 patients cohort of pancreatic and biliary tract cancer PM undergoing oxaliplatin or cisplatin/doxorubicin PIPAC, the pathological response rate was 42% and 62%, respectively. Concerning safety, there was just one intraoperative bowel perforation and no severe postoperative adverse events.
PIPAC was feasible and safe, with the pathological response observed suggesting a high antitumoral activity. Despite such encouraging outcomes, the present research, as well as most of the literature, is affected by several biases and the resulting evidence is controversial. More phase I and II trials might be necessary to fill this knowledge gap.
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Crispo, James Alexander George. "Pharmacotherapies in Parkinson Disease: Investigating Trends and Adverse Health Outcomes." Thesis, Université d'Ottawa / University of Ottawa, 2016. http://hdl.handle.net/10393/35065.
Full textAbstract:
Parkinson disease (PD) is the second most common neurodegenerative disease worldwide, with estimates suggesting that PD prevalence and incidence will increase with aging populations. Therapeutic options and clinical guidelines for PD have significantly changed over the past 15 years; however, pharmacoepidemiology data in PD are lacking, especially regarding adverse effects of non-ergot dopamine agonists (DAs) and outcomes associated with anticholinergic burden. The objectives of this doctoral research are threefold: 1) examine patterns of antiparkinson drug use in relation to clinical guideline publication, drug availability, and emerging safety concerns; 2) determine whether PD patients treated with non-ergot DAs are at increased risk of adverse cardiovascular or cerebrovascular outcomes; and 3) determine whether anticholinergic burden is associated with adverse outcomes in PD. Specific research questions were investigated using epidemiological methods and electronic health data from Cerner Health Facts®, an electronic medical record database that stores time-stamped patient records for more than 300 Cerner subscribing facilities across the United States. Findings from this work are reported in a series of manuscripts, all of which have been published. Key findings include: 1) DA use began declining in 2007, from 34% to 27% in 2012. The decline followed publication of the American Academy of Neurology’s practice parameter refuting levodopa toxicity, pergolide withdrawal, and pramipexole label revisions; 2) heart failure was the only adverse cardiovascular or cerebrovascular outcome that demonstrated a significant association with non-ergot DA use, mainly pramipexole; and 3) anticholinergic burden in PD was associated with the diagnosis of fracture and delirium, and significantly increased the risk of emergency department visit and readmission post inpatient discharge. Reported antiparkinson prescribing trends suggest that safety and best practice information may be communicated effectively in PD. Although findings warrant replication, individuals with PD and independent risk factors for or a history of heart failure may benefit from limited use of pramipexole. Similarly, individuals with PD may benefit from substituting non-PD medications with anticholinergic effects for equally effective non-anticholinergic agents. Additional pharmacovigilance studies are needed to better understand health risks and the impact of population health interventions in PD.
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Lesedi, Kenneth Terhemen. "Integrating road traffic safety education in the teaching and learning of science and technology / by Kenneth T. Lesedi." Thesis, North-West University, 2005. http://hdl.handle.net/10394/841.
Full textAbstract:
The title of the study is integrating road traffic safety education in the teaching and
learning of science and technology. The overall goal of this study was to develop a
tool for the integration of Traffic Safety Education (TSE) in the teaching and
learning of Science and Technology in School. As such, four research questions
(stated in 1.2.1 to 1.2.5) were raised on critical aspects of the problem so as to
direct the course of the study to provide solutions to the problem. These research
questions were formulated into the aims of the study as stated in section 1.3. To
attain these aims, a literature study and interviews were conducted.
Through interviews and a literature study, it was found (among other things)
that:
• TSE has great potential for the reduction of road accidents/ collisions, and its
teaching in school will prepare our learners to be safe road users.
• Science and Technology has tremendous impact on traffic safety, and the
three have much in common, which does provide room for them to be
integrated in school curricula.
• School educators are not adequately equipped to integrate TSE in the
different learning areas.
Consequently, an integration model called "Multilateral learning area
integration model" has been developed for the integration of TSE in the learning
areas of natural science and technology (see 7.2 and 7.3for details).
Eleven recommendations were made in section 8.4 on the basis of the conclusions
(in section 8.3) drawn from the proceedings of interviews and the literature
study. These recommendations if implemented accurately, would undoubtedly contribute
to solving the problem investigated in the study.
This study has therefore made a valuable contribution to laying a solid foundation for
Combating the problem of high road accidents/collisions on South African roads.Thesis (Ph.D. (Education))--North-West University, Potchefstroom Campus, 2005.
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Jackson, Pulver Lisa Rae. "An argument on culture safety in health service delivery: towards better health outcomes for Aboriginal peoples." Thesis, The University of Sydney, 2003. http://hdl.handle.net/2123/609.
Full textAbstract:
The bureaucratic measure of health service, health performance indicators, suggest that we are not effective in our legislative responsibility to deliver suitable health care to some of the populations we are meant to serve. Debate has raged over the years as to the reasons for this, with no credible explanation accepted by those considered stakeholders. One thing is clear though, we have gone from being a culture believing that the needs of the many far outweigh those of the few, to one where we are barely serving the needs of the 'any'. This is most evident in the care delivered to the Aboriginal and Torres Strait Islander people of Australia.
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Jackson, Pulver Lisa Rae. "An argument on culture safety in health service delivery towards better health outcomes for Aboriginal peoples /." University of Sydney. Public Health and Community Medicine, 2003. http://hdl.handle.net/2123/609.
Full textAbstract:
The bureaucratic measure of health service, health performance indicators, suggest that we are not effective in our legislative responsibility to deliver suitable health care to some of the populations we are meant to serve. Debate has raged over the years as to the reasons for this, with no credible explanation accepted by those considered stakeholders. One thing is clear though, we have gone from being a culture believing that the needs of the many far outweigh those of the few, to one where we are barely serving the needs of the 'any'. This is most evident in the care delivered to the Aboriginal and Torres Strait Islander people of Australia.
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Molefe, Sipho Johannes. "The educational role and value of junior traffic training centres within the Outcomes-based education curriculum / Sipho Johannes Molefe." Thesis, North-West University, 2004. http://hdl.handle.net/10394/223.
Full textAbstract:
The aim of this study was to outline the importance of Junior Traffic Training Centres in both
primary and secondary schools. This would aid the effective integration of Traffic Safety
Education in the school curriculum within outcomes-based education. The primary objective of
this research was to determine the ways in which Junior Traffic Training Centres at schools are
instrumental in the development of knowledge, skills and attitudes of learners towards safe
participation in traffic environment. This research was conducted by means of a literature study
and an empirical investigation through a questionnaire and observations.
Investigation focused on learners from three schools, namely Maheelo Primary School (a farm
school at Hartbeesfontein), Gaenthone Secondary School (a semi-rural school in Tigane
Township near Hartbeesfontein) and Phaladi Combined School situated in Ikageng Township.
It was found that more emphasis should be placed on pedestrian education. Learners should be
taught traffic safety from pre-school, with the help of Junior Traffic Training Centres.
Ten recommendations are made in Section 7.5. These include more training in Traffic Safety
Education and that focus must be placed on disadvantaged areas; that government should avail
trained teachers in Traffic Safety Education; and that schools must have access to Junior Traffic
Training Centres.
This study is of significance to the North West Province and the South African society because
each day we lose learners through road accidents. This does not only cost the government
money but is also painful to all of us. This study maintains that teaching our learners road safety
education could contribute towards overcoming this situation.Thesis (M.Ed.)--North-West University, Potchefstroom Campus, 2004.
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Tien, Quang, Jared Sivinski, and Darren Lew. "Evaluation of Safety and Efficacy Outcomes from use of Extended Infusion of Beta-Lactam in the treatment of Acute Pulmonary Exacerbations in Cystic Fibrosis." The University of Arizona, 2017. http://hdl.handle.net/10150/624204.
Full textAbstract:
Class of 2017 AbstractObjectives: The objective of this retrospective cohort chart review was to evaluate the safety and efficacy of extended infusion beta-lactam regimens as part of treatment of acute CF pulmonary exacerbations in adults and pediatric patients. Methods: Inclusion criteria: adult and pediatric patients (age 1 month or older) with CF diagnosis who were admitted to BUMC-T for acute pulmonary CF exacerbation, and who received meropenem, imipenem, aztreonam, piperacillin-tazobactam, and or cefepime during their hospitalization (between 1/1/2011 and 10/30/2015). Exclusion criteria: pregnant women and admissions less than 24 hours. The two groups evaluated were patients receiving treatment (group 1) prior to extend infusion practices (Jan 2011 – Dec 2012) and (group 2) after implementation of extend infusion practices (Jan 2013 – Oct 2015). Data was collected from medical records using both the Sunrise Clinical Manager and EPIC electronic medical record systems. The data was then analyzed for differences in efficacy outcomes (e.g., length of hospitalization, lung function, return to baseline lung function), changes in renal and hepatic function, incidence of documented adverse drug effects, and potential factors associated with increased risk for changes in renal or hepatic function with use of extended infusion beta‐lactam regimens. Results: Pending. Efficacy outcomes: - length of hospitalization - improvement in lung function - return to baseline lung function Safety outcomes: - changes in renal and hepatic function - incidence of documented adverse drug effects - potential factors associated with increased risk for changes in renal or hepatic function Conclusions: Pending. As this study is being conducted at one academic medical center, conclusions may not be generalizable to other institutions.
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Havaei, Farinaz. "The effect of mode of nursing care delivery and skill mix on quality and patient safety outcomes." Thesis, University of British Columbia, 2016. http://hdl.handle.net/2429/59936.
Full textAbstract:
Aims: This study examined the effect of various components of a model of nursing care delivery, the mode of nursing care delivery and nursing skill mix on (a) quality of nursing care (i.e., nurse reported quality of nursing care and nursing tasks left undone), (b) patient adverse events, and (c) nurse outcomes (i.e., job satisfaction and emotional exhaustion) after controlling for nurse demographic characteristics, work environment and workload factors. This study also explores the moderating effects of mode of nursing care delivery and skill mix on the relationship between workload factors and the five outcome variables.
Background: Research into redesigning care delivery has typically focused on only one care delivery component at a time (e.g., skill mix). There exists little research focusing on both components, and controlling for one factor while the other is investigated to determine quality of nursing care delivery and nurse and patient outcomes.
Method: This cross-sectional exploratory correlational survey study drew upon secondary data from 416 direct care registered nurses (RNs) from medical-surgical settings.
Results: Nurses working in a team-based mode of care delivery reported a greater number of nursing tasks left undone compared to those working in a total patient care mode of delivery. Nurses working in a skill mix with licensed practical nurses (LPNs) reported a higher frequency of patient adverse events compared to those working in a skill mix without LPNs. Two moderating effects were found. At higher levels of acuity, nurses in a team-based mode of care delivery reported a higher frequency of patient adverse events than did nurses in a total patient care mode of delivery. At higher levels of acuity, nurses working in a skill mix with LPNs reported lower levels of emotional exhaustion than nurses in a skill mix without LPNs.
Conclusion: Models of nursing care delivery components influenced quality and safety outcomes.
Implications: To be effective, a team-based mode of care delivery requires collaborative teamwork. Policy makers, administrators and healthcare providers should work together to clarify and optimize the scopes of practice for RNs and LPNs.Applied Science, Faculty of
Nursing, School of
Graduate
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Soloway, Julie A. "Institutional capacity to constrain suboptimal welfare outcomes from trade-restricting environmental, health and safety regulation under NAFTA." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp03/NQ49919.pdf.
Full text
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Lyon, Julie Stella. "The missing link an examination of safety climate and clinical outcomes in a national sample of hospitals /." College Park, Md. : University of Maryland, 2007. http://hdl.handle.net/1903/6834.
Full textAbstract:
Thesis (Ph. D.) -- University of Maryland, College Park, 2007.Thesis research directed by: Psychology. Title from t.p. of PDF. Includes bibliographical references. Published by UMI Dissertation Services, Ann Arbor, Mich. Also available in paper.
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Grundy, Lynne. "Crossing the boundaries : nurses in the medical domain : an examination of safety and outcomes in secondary care." Thesis, Swansea University, 2014. https://cronfa.swan.ac.uk/Record/cronfa42750.
Full textAbstract:
Background and Aims Nurses' roles, responsibilities and practice have changed and the boundaries between nursing and medicine have blurred. Few studies compare clinical outcomes of patients managed by Advanced Nurse Practitioners (ANPs) and junior doctors in acute secondary care. Aims of the study were to identify any observable differences between ANPs undertaking traditional junior doctor roles and junior doctors in relation to senior doctor congruence with diagnosis and clinical management planning, and clinical assessment practices. Setting The study took place in an acute hospital in the UK from April 2009 to August 2010. Design and methods This was a retrospective review of clinical records of patients presenting to the emergency medicine division. Data were collected from 311 randomly selected case notes of patients presenting to 10 ANPs and 10 junior doctors. Data were analysed using bivariate and multivariate techniques in SPSS version 19. Analyses were repeated including only patients presenting to Acute Medical Assessment Unit (AMA). Findings Statistically significant findings included: patients presenting to junior doctors were older, had more co-existing problems and were prescribed more medicines before presentation. Patients presenting to ANPs were more likely to have chest pain. ANPs were less likely to prescribe medicines. Clinical management plans were less likely to be agreed for patients with more coexisting problems. There were few inter-professional differences in senior congruence with clinical management planning and diagnosis and clinical assessment practices. These findings are reassuring as nurses' work moves into what was formerly the medical domain.
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Nkhungulu, Chao Feramo. "Explanatory model of antecedents and outcomes of health and safety climate in the South African construction industry." Doctoral thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/9303.
Full textAbstract:
Includes bibliographical references.Workplace injuries and fatalities are a major cause of concern for government and organisations in South Africa. The cost incurred by government as compensation for injuries that occur in the workplace has increased steadily over the past 10 years. This has raised the need for alternative approaches to dealing with causes of workplace injuries and fatalities. The loss of employees due to workplace fatalities and the cost of medical care have both direct and indirect cost implications for organisations. The cost of hiring replacement labour while the injured employee is on leave, the cost of training a new employee, paying for medical care for the original employee, and reduced productivity due to lack of experience of the incoming replacement are financially draining and detrimental to the functions of organisations. The primary objective of the study being reported here was to develop an explanatory model of the health and safety (H&S) climate in the local construction industry. A secondary objective was to provide a theoretical and practical framework for the study of the health and safety climate in the South African construction industry. A literature review, observations and structured interviews informed the development of a survey questionnaire. The survey was completed by construction workers who were members of the Master Builders Association South Africa (MBASA) in the Western Cape. On-site observations and structured interviews by the researcher informed the development of a pen-and-paper survey, which was completed by construction workers at selected building sites from organisations who were members of MBASA. A pilot study was conducted for refinement of the survey measurement tool. Hypotheses were tested using regression analysis techniques. Partial least squares path analysis was used to test the structure of the proposed model. In total, 1 200 surveys were administered, and a total of 851 participants completed the survey. This study provided empirical evidence of the link between antecedents of the health and safety climate and health and safety performance. Overall, the proposed health and safety model showed significant predictive ability for health and safety incident reporting (R² = .464, p = <.001), health and safety motivation (R² = .450, p = <.001) and health and safety performance (R² = .508, p = <.001). Path analysis found a predictive ability of health and safety performance to injuries (R² = .028, p = <.001). The findings provided evidence-based support for the variables of top management's commitment to health and safety and health and safety communications and the predictive ability of these on positive health and safety behaviour. Predicting injuries in the construction industry can help to reduce the high costs of compensation and make employees in the sector safer. Insights gained from this study will contribute to the field of occupational health psychology in particular at both academic and practical level.
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McNamara, Maria Organisation & Management Australian School of Business UNSW. "A comparative study of the occupational health and safety outcomes of permanent and temporary hotel workers in Ireland and Australia." Awarded by:University of New South Wales. Organisation & Management, 2009. http://handle.unsw.edu.au/1959.4/43417.
Full textAbstract:
A substantial body of literature links precarious employment with increased exposure to occupational hazards and adverse OHS outcomes. While a majority of these studies has found that precarious work has adverse effects on OHS outcomes, findings are more mixed with regard to temporary employment (the focus of this study), and there are still many gaps in the research that have yet to be addressed. Various models have been proposed in an attempt to explain the causal mechanisms behind the health effects of precarious employment. However, relatively few studies have empirically investigated these mechanisms. There is also a dearth of research on the effects of precarious work on OHS outcomes in parts of the service sector, such as hospitality, despite the fact that these industries make extensive use of precarious work arrangements. Further, few studies have been based on international comparative data (and even fewer where the focus has been on a particular industry). This thesis seeks to address these gaps by investigating OHS outcomes of hotel workers engaged under different employment arrangements in Ireland and Australia. There are two principle objectives to the study. The first is to examine OHS outcomes, while the second is to test and refine the Quinlan, Mayhew and Bohle (2001) Three Factor Model in an attempt to explain the links between health and precarious employment. It also aims to enhance the understanding of the mechanisms by which these factors interact to influence outcomes. This study defines and tests a health and injury structural model. The structural equation modelling techniques employed have not been used in previous studies in this area and provide a clearer portrayal of the complex relationships between the many variables affecting the OHS of precarious employees in the hotel industry. The OHS outcomes range from exposure to occupational violence and stress to a wide variety of debilitating physical ailments. This research also highlights several indirect or spillover effects of precarious employment. The inconsistencies between both locations are mainly regarding perceived job security, economic and reward pressures and lack of control over working hours. Despite these differences, there are basic similarities between the locations that are important.
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Chukmaitov, Askar S. "Variations in Quality Outcomes Among Hospitals in Different Types of Health Systems." VCU Scholars Compass, 2005. https://scholarscompass.vcu.edu/etd/1414.
Full textAbstract:
Although prior research has found differences in costs and financial performance across different types of hospital systems, there has been no systematic study of variations in patient quality of care or safety indicators across different systems. Our study examines whether five main types of health systems - centralized (CHS), centralized physician/insurance (CPIHS), moderately centralized (MCHS), decentralized (DHS), and independent (IHS) - as well as other hospital characteristics are associated with differences in quality of patient care. Data were assembled for 6 years (1995 - 2000) from multiple sources. We used 4 AHRQ risk adjusted inpatient quality indicators (IQIs) and 5 risk-adjusted patient safety indicators (PSIs) as dependent variables. Random effects models were used in the analysis.It was found that the IQI and PSI models have different patterns. In the IQI models, CHS hospitals have lower AMI, CHF, Stroke, and Pneumonia mortality rates than hospitals in other system types. The PSI models did not indicate any systems' effects on adverse event rates. It was also found that system hospitals' compliance with the JCAHO performance area indicator for availability of patient specific information was associated with lower rates of CHF, Stroke, Pneumonia, and Infection due to medical care.The findings suggest that centralization of hospital structures may improve internal clinical processes by enhancing coordination of activities, communication between providers, timely adjustments of processes of care delivery and structures to external pressures. A lack of systems' effect on adverse events may be explained by a newness of the patient safety issues for hospitals and possible changes in reporting patterns of medical errors after the Institute of Medicine report of 1999. A system hospitals' compliance with the JCAHO performance area indicator may indicate improvements in information and clinical record systems.Hospital systems hold much potential for hospitals in improving patient quality of care and safety because they provide a laboratory for studying the health care process and sharing lessons across multiple institutions. Based on our findings, we recommend that future studies use a combination of IQIs and PSIs when examining institutional quality of care because both provide different and complementary information.