Health information technology has been widely accepted as having the potential to decrease the prevalence of adverse events and improve workflows and communication between healthcare workers. However, the emergence of health technologies has introduced a new type of medical error. Technology-induced errors are a type of medical error that can result from the use of health information technology in all stages of the health information systems life cycle. The purpose of this study is to identify what types of technology-induced errors are present in the key health information technology vendors in the United States, determine if there are any similarities and differences in technology-induced errors present among the key health information technology vendors in the United States, and determine what methods are utilized, if any, by the key vendors of health information technologies to address and/or resolve reported technology-induced errors. This study found that the most commonly reported technology-induced errors are those related to unexpected system behaviours, either through their direct use or through the communication between systems. It was also found that there is a large difference in the number of adverse events being reported by the key health information technology vendors. Just three vendors represent 85% of the adverse events included in this study. Finally, this study found that there are vendors who are posting responses to reported technology-induced errors and these vendors are most commonly following up with software updates and notifications of safety incidents. This study highlights the importance of analyzing adverse event reports in order to understand the types of technology-induced errors that are present in health information technology. / Graduate

Given the high number of errors and negative events committed within medical settings, the emphasis on patient safety culture is becoming more prevalent. Despite this effort, underreporting has been and continues to be an issue in this area. Some research has shown a link between underreporting and lack of management responsiveness, but more work is necessary to identify reasons for underreporting and potential mitigating solutions. The objective of the present research is to answer questions regarding the impact supervisors have on staff’s patient safety perceptions and event reporting, through the use of archival survey data collected with the AHRQ Hospital Safety Culture Survey (2004). Probable moderators and mediators of key relationships were explored as well. Results are presented and their implications are discussed herein.

Studies suggest that the majority of hospital errors go unreported. Equally disturbing is that data surrounding near miss events that could have harmed patients has been found to be even sparser. At the core of any medical error reporting effort is a desire to obtain data that can be used to reduce the frequency of errors, reveal the cause of errors, and empower those involved in the healthcare delivery system with the insight required to design methods to prevent the flaws that allow mistakes to occur. Aligned with the adage that “we can’t fix what we don’t know is broke”, the question is raised why does underreporting exist? The likelihood of reporting medical errors is explored as a manifestation of culture. Factors studied include communication and feedback, teamwork, fear of retribution, and leadership support (top management and supervisor). Data is presented using a nationally recognized instrument—the Agency for Healthcare Research and Quality (AHRQ) Culture of Safety survey. Findings from the research are mixed with little positive relationship between the model and number of events reported although each factor is found to be positively associated with an employee’s perceived frequency by which near miss and no harm events are reported. While advances in patient safety have materialized, the act of employees’ actually reporting events still pales in comparison to the number of errors that have likely occurred, regardless of efforts to advance culture. To explore influencers beyond those found in the AHRQ Culture of Safety survey, an overlapping model is presented. This includes studying various underlying factors, such as understanding what constitutes a reportable event, ease of reporting, and knowledge of the processes supporting data submission, along with attempting to better assess the impact of the direct supervisor and incentives in influencing behavior. Findings suggest that these additional factors do contribute, albeit modestly, to the act of reporting errors. When adding tenure and patient interaction to the model, a higher percentage of the variance is explained. In terms of perceived frequency of reporting near misses and no harm events, this model yields similar results to the first, explaining approximately 28% of the variance. The two factors most positively associated with perceived frequency of reporting near miss and no harm events are communication and feedback and infrastructure —suggesting that some unexplored relationship may exist between the overlapping models. / Business Administration/Interdisciplinary

An organizational culture of safety affects employees' attitudes, beliefs, perceptions, and values related to safe practice as well as their behaviors and level of engagement. The purpose of this project was to determine the influence of introducing the just culture model through staff engagement in an interactive workshop. A convenience sample of acute care staff were recruited for this 1-sample pretest and posttest project design. The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture instrument was used to measure safety culture perceptions on 7 dimensions pre and post intervention. For the theoretical framework, Ajzen's theory of planned behavior and Kantar's empowerment theory were used. Welch's t test results showed significant improvement in perception scores overall (t = 2.7, p < 0.01), with posttest mean scores ('= 3.7) higher than pretest mean scores ('= 3.5). The dimension-specific mean posttest scores were significantly higher on 3 of the 7 dimensions including teamwork (t = 2.99, p < 0.05), feedback and communication (t = 2.14, p < 0.05), and frequency of event reporting (t = 2.31, p < 0.05). Major implications for social change include reduction of preventable errors and iatrogenic events; creating a healthcare environment that is safe, fair, transparent, and reliable; creating organizational learning through evidence-based patient safety training; and promoting the use of perception surveys to measure and improve the culture in one's organization. The project may provide a road map for just culture implementation. Future qualitative and quantitative research should explore effects of a just culture on safety reporting patterns and specific events such reducing medication errors or risk-taking behaviors.

The U.S. Food and Drug Administration (FDA) uses the FDA Adverse Event Reporting System (FAERS) to monitor adverse events resulting from pharmaceutical drug use. However, this system has limitations such as not allowing real-time data collection. To address these limitations, the FDA launched the Sentinel Initiative in 2008. This comparative case study was conducted to describe perceptions of investigating the efficacy of the Sentinel Initiative compared with the FAERS. The study was based on the theory of preemption as it emphasized the need for efficient means for providing unquestionable proof that consumers suffered adverse drug effects. The sample included interivews of 20 individuals, who worked closely with the FAERS program and were familiar with the Sentinel Initiative. In-depth key-informant interviews had been conducted to determine the perceptions of the participants regarding the challenges and benefits of the Sentinel Initiative compared with FAERS. To analyze data, content analysis was used. The study concluded that the FAERS and Sentinel Initiative provided a systematic database, which included health data, that could be used to improve public health. Due to the FAERS and Sentinel Initiative, adverse effects of drugs will be recognized and the safety of the patients and the public will be prioritized. The findings of this study have potential social impact for positive change at the societal level, organizational level, and individual level in terms of overall safety of the drugs. Sentinel initiative at its present state complements the existing FAERS and leverage its benefits by connecting at a grass roots level patients to an organization level as well as stakeholders to make an impact in providing safer drugs on the market.

Football is the world’s biggest sport, and every match requires a referee who is responsible for interpreting and enforcing the Laws of the Game. In Sweden, an area for improvement for referees is the user experience of the administration tool used to collect data about matches. By enhancing existing tools and systems, there is potential for greater efficiency and ease of use in administrative tasks performed by the referee. By following the Double Diamond Model of Design, this study investigated a suitable way to design an interface for referees covering the activities they perform in conjunction with a match, including the administrative part of match reporting. In the first phase, Discover, information about the referee’s activities, pain points, and wants was collected through interviews and an observation. The data was then organised and analysed in the Define phase, through affinity diagramming and by creating a current state map. In the Develop phase, different interface solutions to the identified activities and issues were explored through a Crazy 8 session. Lastly, the final Deliver phase consisted of three iterations of creating prototypes, which were evaluated through usability testing, a design critique, and a final user test.  The major pain point that was identified during the study’s first two phases was filling out the referee match report in the administrative system after each match based on the notes taken during it. Additional activities and aspects were also discovered that had an impact on the design concept for a smartphone. The design proposal consisted of three parts: (1) a referee feed, including information that might be relevant to the referee when preparing for a match; (2) a reporting tool for reporting events, in which it would be possible to report them live during the match instead of after it; and (3) the option to give feedback on the players, coaches, and supporters. While the reporting of penalty misses was discovered to need further consideration, testing mainly resulted in positive feedback about the concept and design, specifically because it removed a major pain point in their work after the match, thus indicating that it serves its purpose and could be used in a first launch of the product. One interesting finding was the perception of the mobile device and how it affects the overall solution. Although the screen size of a smartphone offers more potential design solutions and functionalities, referees feel it might be unprofessional to carry a phone onto the pitch. / Fotboll är världens största sport, och varje match kräver en domare som ansvarar för att tolka och upprätthålla spelreglerna. Ett förbättringsområde för domare i Sverige är användarupplevelsen i det administreringsverktyg som används för att samla in data om matcher. Genom att förbättra befintliga verktyg och system finns det potential för större effektivitet och användarvänlighet i de administrativa uppgifter som domaren utför. Genom att följa metoden Double Diamond undersöktes i denna studie ett lämpligt sätt att designa ett gränssnitt för domare, som täcker de aktiviteter de behöver utföra i samband med match, inklusive den administrativa delen av matchrapporteringen. I den första fasen, Discover, samlades data in om domarens aktiviteter, behov och önskemål, genom intervjuer och en observation. Informationen organiserades och analyserades sedan i Define-fasen, genom affinity diagramming och skapandet av en current state map. I Develop-fasen utforskades olika gränssnittslösningar för de identifierade aktiviteterna och problemen genom en Crazy 8-session. Slutligen bestod den sista Deliver-fasen av tre iterationer med skapande av prototyper, som utvärderades genom användbarhetstester, en design critique och ett slutligt användartest. Det största problemet som identifierades under studiens två första faser var att fylla i matchrapporten i administreringsverktyget efter varje match, baserat på anteckningarna som skrivits under den. Fler aktiviteter och aspekter identifierades också som hade en inverkan på designförslaget för smartphone. Det framtagna designförslaget bestod av tre delar: (1) ett domarflöde innehållande information som kan vara relevant för domaren när hen förbereder sig för en match, (2) ett domarverktyg för att rapportera händelser, i vilket det är möjligt att rapportera dessa live under matchen i stället för efter den, och (3) möjligheten att ge feedback om spelarna, tränarna och supportrarna. Medan hanteringen för att rapportera in straffmissar behöver utredas mer, resulterade testerna främst i positiv feedback gällande konceptet och designen, framför allt då det underlättade arbetet med matchrapporten efter matchen, vilket tyder på att den tjänar sitt syfte och kan användas vid en första lansering av produkten. En intressant iakttagelse var uppfattningen och synen av mobilenheten och hur den påverkar den övergripande lösningen. Även om skärmstorleken på en smartphone erbjuder fler potentiella designlösningar och funktioner, kan domare tycka att det känns oprofessionellt att bära med sig en telefon på planen.

El principal objetivo de éste proyecto de investigación es la definición de una arquitectura que permita la protección y gestión de los derechos digitales en un entorno de gestión de contenido multimedia, siguiendo estándares abiertos siempre que sea posible. A fin de conseguir dicho objetivo, se analizarán y considerarán múltiples estándares e iniciativas relacionados.En primer lugar se aborda la definición de una arquitectura preliminar basada en MPEG-21 que permite la protección y gestión de los derechos digitales (DRM) aplicables a contenido multimedia. Más adelante, se presenta una arquitectura genérica y se describen diferentes implementaciones desarrolladas en proyectos nacionales y europeos, como AXMEDIS, VISNET II, Linked-Work y GILDDA. El análisis incluye casos de uso, aspectos de seguridad y la propuesta de una metodología de prueba o test. En el caso de Linked-Work, se detalla una implementación específica, resaltando los conceptos clave que la hacen diferente de otros sistemas de DRM. / The main goal of this research project is to define a generic architecture for the protection and management of digital rights in a multimedia content management scenario following open standards as much as possible. In order to achieve this goal, several standards and initiatives will be analysed and taken into account.First, a MPEG-21-based preliminary architecture for the protection and management of digital rights for multimedia content is tackled. Later on, a more general architecture is defined. Several implementations are described such as those in several Spanish and European projects such as AXMEDIS, VISNET II, Linked-Work and GILDDA. The focus in made on use cases, security features and a testing methodology. Linked-Work details a specific implementation, emphasising on the key concepts that make it different from other kind of DRM systems.

No description available.

Background: The increasing consumption of dietary supplements (DS) has drawn the attention of regulatory agencies, researchers and healthcare professionals. The US Food and Drug Administration (FDA) does not require premarketing assessment of DS considering them safe unless proven otherwise. However, the reporting rate of DS adverse events (DS-AE) is low. Objective: To describe pharmacists’ attitudes and knowledge of DS and DS information resources, and to determine the importance of selected attributes in pharmacists’ decisions to report a DS-AE. Methods: A convenience sample of practicing pharmacists in Virginia was surveyed using a web-based self-administered questionnaire. A conjoint analysis exercise was developed using several scenarios based on a set of five attributes: patient’s age, initiation of DS, last modification in drug therapy, evidence supporting the AE, and outcome of the AE. Participants were asked to indicate their decision to report the AE in each scenario to prescriber, drug manufacturer, DS manufacturer and FDA on a 6-point ordered scale. Participants’ attitude, knowledge of DS, demographic information, and DS information resources were also requested. Linear regression models were used to determine the relative importance of the profile attributes on a pharmacist’s decision to report the AE. The effects of other characteristics on the importance of the attributes were assessed. Results: Participants’ overall attitudes were relatively positive for the clinical use of DS but negative for safe of DS. Formal training on DS was associated with better knowledge of DS regulation. The average knowledge score of DS identification was relatively good but was low for DS regulation. Lexi-Comp® was the most widely used and available information resource and the Natural Medicines Comprehensive Database was the most useful once. The most important attribute that a pharmacist considered in the decision to report a DS-AE to DS manufacturer, drug manufacturer and FDA was the outcome of the AE followed by the evidence supporting the AE. Ranking of these two factors was the reversed in reporting to prescriber. Conclusions: Outcome and evidence of the AE are the most important factors participants considered when reporting. Other characteristics do not have an impact on the relative importance of the attributes.

Els sistemes de gestió de drets digitals controlen l'ús del contingut multimèdia a través de tota la cadena de valor digital. Aquesta tesis contribueix als diferents aspectes de la gestió dels drets digitals i de la protecció de la propietat intel·lectual.La contribució d'aquest tesi és la definició de formats i mecanismes estàndards que permetin la gestió del contingut a través de la cadena de valor digital. Els formats i els mecanismes seran estàndards, de forma que permetran la interoperabilitat entre sistemes de DRM que segueixin l'estàndard MPEG-21.També s'han dissenyat mecanismes estàndards per governar continguts digitals, protegir la propietat intel·lectual i per a la gestió i protecció de les notificacions d'esdeveniments dins dels sistemes de gestió de drets digitals. / Los sistemas de gestión de derechos digitales controlan el uso del contenido multimedia a través de toda la cadena de valor digital. Esta tesis contribuye a diferentes aspectos de la gestión de los derechos digitales y de la protección de la propiedad intelectual.La contribución de esta tesis es la definición formatos y mecanismos estándares que permitan la gestión del contenido a través de la cadena de valor digital. Los formatos y mecanismos serán estándares, de forma que permitirán la interoperabilidad entre sistemas de DRM que sigan el estándar MPEG-21. También se han diseñado mecanismos estándares para gobernar contenidos digitales, proteger la propiedad intelectual y para la gestión y protección de las notificaciones de eventos dentro de los sistemas de gestión de derechos digitales. / Digital rights management systems control the use of multimedia content through the complete digital value chain. This thesis contributes in different aspects of the digital rights management and of the protection of the intellectual property.Main contribution of this thesis is the definition of standardised formats and mechanisms that enable the management of governed multimedia content through the digital value chain. The formats and mechanisms will be standard in order to enable interoperability between DRM systems compliant to the MPEG-21 standard.Different mechanisms have also been defined to govern digital content, protect the intellectual property and for the management and protection of the event reports within digital rights management systems.