published_or_final_version / Law / Doctoral / Doctor of Philosophy

Este trabalho tenta colocar em evidência dois pontos dos mais atuais, tanto na área da Medicina como no Direito: a falha técnica e a correspondente reparação do dano por ela causado. Para o desenvolvimento deste trabalho, foram utilizados processos judiciais de primeira instância no período de 1995 a 2003 correlacionados às cirurgias do aparelho digestivo. Buscou-se definir os perfis dos médicos mais processados, que pagam maiores valores indenizatórios, bem como de outro lado os pacientes que mais processam e mais recebem valores indenizatórios, nos processos analisados. Os parâmetros, principais de análise foram as sentenças proferidas em primeira instância, em casos de condenação do médico e os respectivos valores envolvidos. Finalmente concluímos que: O perfil do paciente que mais processa médico: 41 a 60 anos, branco, feminino, católico com nível superior e detentor de justiça gratuita. O perfil do paciente recebe maiores valores médios indenizatórios: 41 a 60 anos, negro, feminino, católico, ensino fundamental e detentor de justiça gratuita. O perfil do médico que é mais processado por erro médico em Cirurgia do Aparelho Digestivo: 41 a 60 anos, branco, masculino, com título de especialista, formado entre 21 a 30 anos, no atendimento de convênio de plano de saúde, não possuindo seguro profissional, em atendimento de urgência/emergência e em equipe multidisciplinar. O perfil do médico que paga maiores valores indenizatórios em processos por erro médico em Cirurgia do Aparelho Digestivo: 21 a 40 anos, branco, masculino, residente, em atendimento em hospital público, não possuindo seguro profissional, em atendimento de urgência/emergência e em equipe multidisciplinar. / This works attempts to highlight two of the most current points, both in the fields of Medicine and Law: technical failure and the corresponding repair of the damage caused by it. For the development of this work, trial-court level proceedings in the period from 1995 to 2003 related to digestive system surgeries were used. The intention was to define the profile of the most prosecuted physicians, who pay the highest indemnification amounts, as well as, on the other hand, the patients that prosecute them most and receive indemnification amounts the most, in the reviewed proceedings. The main parameters for analysis were the judgments issued at trial-court level, in cases of conviction of the physician and the corresponding amounts involved. Finally, we concluded that: The profile of the patient who prosecutes the physician the most: 41 to 60 years old, Caucasian, female, catholic with higher education and entitled to free-of-charge justice. The profile of the patient who receives the highest average indemnity amount: 41 to 60 years old, black, female, catholic with primary education and entitled to free-of-charge justice. The profile of the physician who is prosecuted the most for medical error in a Surgery of the Digestive System: 41 to 60 years old, Caucasian, male, with a specialist degree, graduated between 21 and 30 years old, operating with health care insurance, and not holding professional insurance, in cases of urgency/emergency and in a multi-disciplinary team. The profile of the physician who pays the highest indemnity amounts in cases of medical error in a Surgery of the Digestive System: 21 to 40 years old, Caucasian, male, resident, working at a public hospital, not holding professional insurance, in cases of urgency/emergency and in a multi-disciplinary team.

Every scheduled treatment at a radiation therapy clinic involves a series of safety protocol to ensure the utmost patient care. Despite safety protocol, on a rare occasion an entirely preventable medical event, an accident, may occur. Delivering a treatment plan to the wrong patient is preventable, yet still is a clinically documented error. This research describes a computational method to identify patients with a novel machine learning technique to combat misadministration.The patient identification program stores face and fingerprint data for each patient. New, unlabeled data from those patients are categorized according to the library. The categorization of data by this face-fingerprint detector is accomplished with new machine learning algorithms based on Sparse Modeling that have already begun transforming the foundation of Computer Vision. Previous patient recognition software required special subroutines for faces and di↵erent tailored subroutines for fingerprints. In this research, the same exact model is used for both fingerprints and faces, without any additional subroutines and even without adjusting the two hyperparameters. Sparse modeling is a powerful tool, already shown utility in the areas of super-resolution, denoising, inpainting, demosaicing, and sub-nyquist sampling, i.e. compressed sensing. Sparse Modeling is possible because natural images are inherrently sparse in some bases, due to their inherrant structure. This research chooses datasets of face and fingerprint images to test the patient identification model. The model stores the images of each dataset as a basis (library). One image at a time is removed from the library, and is classified by a sparse code in terms of the remaining library. The Locally Competetive Algorithm, a truly neural inspired Artificial Neural Network, solves the computationally difficult task of finding the sparse code for the test image. The components of the sparse representation vector are summed by `1 pooling, and correct patient identification is consistently achieved 100% over 1000 trials, when either the face data or fingerprint data are implemented as a classification basis. The algorithm gets 100% classification when faces and fingerprints are concatenated into multimodal datasets. This suggests that 100% patient identification will be achievable in the clinal setting. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2016. / FAU Electronic Theses and Dissertations Collection

Care of the elderly, long-term care resident in the emergency department is an issue of importance because of the overall impact on healthcare costs, potential for negative outcomes for the resident, and the loss of revenue. The purpose of this project was to decrease avoidable transfer of residents to the Emergency Department. Using the Antecedent, Target, Measurement logic model, poor quality assessment data was deemed the antecedent of the avoidable transfer. The goal of the project was the implementation of a standardized process of assessment that would have decreased avoidable transfer of the resident. The project would have involved training of the nursing staff in the use of the Situation Background Assessment and Recommendation tool for collecting and communicating pertinent data. The tool would have been completed at each acute complaint and would have indicated disposition. Data would have been collected by the Education Coordinator and organized for review and comparison with preintervention data. Social change implications would have included enhanced communication, potential for increased nurse and physician satisfaction which could have potentially increased job satisfaction, and improved recruitment and retention. Autonomy and self-pertinence empowers the nurse to be a stronger advocate. Positive outcomes increase when care is provided by those familiar with the patient norms and the setting. Financial savings can have an impact on the cost of healthcare. This project would also have allowed for and encouraged internal review of process and practices. This project was not implemented and so remains inconclusive.

Background: Most errors in the venous blood testing process are preanalytical, i.e. they occur before the sample reaches the laboratory. Unlike the laboratory analysis, the preanalytical phase involves several error-prone manual tasks not easily avoided with technological solutions. Despite the importance of the preanalytical phase for a correct test result, little is known about how blood samples are collected in hospitals. Aim: The aim of this thesis was to survey preanalytical procedures in hospitals to identify sources of error. Methods: The first part of this thesis was a questionnaire survey. After a pilot study (Paper I), a questionnaire addressing clinical chemistry testing was completed by venous blood sampling staff (n=314, response rate 94%) in hospital wards and hospital laboratories (Papers II–IV). The second part of this thesis was an experimental study. Haematology, coagulation, platelet function and global coagulation parameters were compared between pneumatic tube-transported samples and samples that had not been transported (Paper V). Results: The results of the questionnaire survey indicate that the desirable procedure for the collection and handling of venous blood samples were not always followed in the wards (Papers II–III). For example, as few as 2.4% of the ward staff reported to always label the test tube immediately before sample collection. Only 22% of the ward staff reported to always use wristbands for patient identification, while 18% reported to always use online laboratory manuals, the only source of updated information. However, a substantial part of the ward staff showed considerable interest in re-education (45%) and willingness to improve routines (44%) for venous blood sampling. Compared to the ward staff, the laboratory staff reported significantly higher proportions of desirable practices regarding test request management, test tube labelling, test information search procedures, and the collection and handling of venous blood samples, but not regarding patient identification. Of the ward staff, only 5.5% had ever filed an error report regarding venous blood sampling, compared to 28% of the laboratory staff (Paper IV). In the experimental study (Paper V), no significant preanalytical effect of pneumatic tube transport was found for most haematology, coagulation and platelet function parameters. However, time-to-clot formation was significantly shorter (16%) in the pneumatic tube-transported samples, indicating an in vitro activation of global coagulation. Conclusions. The questionnaire study of the rated experiences of venous blood sampling ward staff is the first of its kind to survey manual tasks in the preanalytical phase. The results suggest a clinically important risk of preanalytical errors in the surveyed wards. Computerised test request management will eliminate some, but not all, of the identified risks. The better performance reported by the laboratory staff may reflect successful quality improvement initiatives in the laboratories. The current error reporting system needs to be functionally implemented. The experimental study indicates that pneumatic tube transport does not introduce preanalytical errors for regular tests, but manual transport is recommended for analysis with thromboelastographic technique. This thesis underscores the importance of quality improvement in the preanalytical phase of venous blood testing in hospitals.

Research suggests that interruptions are ubiquitous in healthcare settings and have a negative impact on patient safety. However, there is a lack of solutions to reduce harm arising from interruptions. Therefore, this research aimed to design and test the effectiveness of interventions to mitigate the effects of interruptions during medication administration. A three-phased study was conducted. First, direct observation was conducted to quantify the state of interruptions in an ambulatory unit where nurses routinely administered high-risk medications. Secondly, a user-centred approach was used to design interventions targeting errors arising from these interruptions. Finally, the effectiveness of these interventions was evaluated through a high-fidelity simulation experiment. Results showed that medication administration error rates decreased significantly on 4 of 7 measures with the use of interventions, compared to the control condition. Results of this work will help guide the implementation of interventions in nursing environments to reduce medication errors caused by interruptions.

Research suggests that interruptions are ubiquitous in healthcare settings and have a negative impact on patient safety. However, there is a lack of solutions to reduce harm arising from interruptions. Therefore, this research aimed to design and test the effectiveness of interventions to mitigate the effects of interruptions during medication administration. A three-phased study was conducted. First, direct observation was conducted to quantify the state of interruptions in an ambulatory unit where nurses routinely administered high-risk medications. Secondly, a user-centred approach was used to design interventions targeting errors arising from these interruptions. Finally, the effectiveness of these interventions was evaluated through a high-fidelity simulation experiment. Results showed that medication administration error rates decreased significantly on 4 of 7 measures with the use of interventions, compared to the control condition. Results of this work will help guide the implementation of interventions in nursing environments to reduce medication errors caused by interruptions.

The objectives of this study were to examine the association between patient perceived healthcare quality and self-reported medical, medication, and laboratory errors using cross-sectional and cross-national questionnaire data from eleven countries. In this research, quality of care was measured by a multi-faceted construct, which adopted the patient's perspectives. Five separated quality of care scales were assessed: Access to Care, Continuity of care, Communication of Care, Care Coordination, and Provider's Respect for Patients' Preferences. The findings from this investigation support a number of other published studies suggesting that Coordination of Care is an important predictor of perceived patient safety. After adjusting for potentially important confounding variables, an increase in peoples' perceptions of Coordination of Care decreased the likelihood of self-reporting medical errors (OR =0.605, 95% CI: 0.569 to 0.653), medication errors (OR =0.754, 95% CI: 0.691 to 0.830), and laboratory errors (OR =0.615, 95% CI: 0.555 to 0.681). Finally, results showed that the healthcare system type governing care processes modifies the effect of Coordination of Care on self-reported medication errors.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Thesis (Ph.D)--University of Wollongong, 2005. / Typescript. Includes bibliographical references: leaf 170-205.