Risk management and healthcare safety: Ten years of experience at the Vienna General Hospital

We should use the word “Health Care Safety” instead of “Patient Safety,” because in cases of malpractice the people who are in charge of treatment of patients can be “second victims.” The typical damage case occurs to an above-average employee in a risk-prone discipline after working in the job for 20 years often between Friday afternoon and Sunday more often in the months of January, March or July due to a preceding communication error and a missing assertiveness of a person who is involved in the case. Very often, health professionals do not know how to react in case of malpractice or emergency from a legal point of view. The patient or his family contact a lawyer immediately, but who helps the health professionals to cope with the case? The Vienna General Hospital (VGH) is one of the biggest in the world. In 1999, the project “Risk Management” was initiated by the Legal Department. The aim at this time was: “Minus 50% concerning cases and more than 50% less costs in the next ten years (2000–2010).” In 2010, the aim was reached and the positive trend is still continuing, but how did it work? The VGH in cooperation with the Vienna Insurance Group created a complete new form of quick help in case of emergency: the so-called “Legal Emergency Kit.” It represents a handy plastic case on which a paragraph is stamped. A special checklist tells what to do in case of legal emergency. The legal practitioner of the VGH can be called at any time via mobile phone. The malpractice cases are analysed in a retrospective damage analysis, which helps to avoid errors and damages in the future.

A model for the relation between respiratory neural and mechanical outputs. II. Methods

In the preceding communication we developed a model for the conversion of neural output to mechanical output. We were left with two qualitative uncertainties, namely, the relation between neural output and isometric pressure, and the behavior of inspiratory muscles during expiratory flow; and two quantitative uncertainties concerning the effect of configurational pathway on pressure output, and the slope of the pressure-flow relation. For each of the above uncertainties we made certain assumptions based on indirect evidence but defined reasonable error limits. In the present communication we describe the method of implementing the model and evaluate the significance, in terms of spirometric output, of possible errors in the assumptions. Volume and flow profiles were generated from different neural output profiles. Analysis was repeated when the different assumptions were systematically altered within the limits set by the previous theoretical analysis. We conclude that the pattern of inspiratory muscle activation during spontaneous breathing and the existence of several mechanical interactions within the respiratory system combine to render spirometric output fairly insensitive to most potential errors in our assumptions.

Synthesis and Properties of a New Kind of One-Dimensional Conductors. 2. Extended Hückel Calculations on the Energy Band Structure

The co-ordination polymer of tetrazaporphin (TAP) with a transition metal, say FeII , in its center and acetylide anion, C22⊖ , as an axial bidentate bridging ligand is taken as a model sub-stance for the new type of one-dimensional conductors introduced in the preceding communication of this series. Although the monomer shows D4h symmetry, this is reduced to C4v for arbitrary kz -values of the Bloch functions of the first Brillouin zone. From the irreducible representations a1, a2, b1, b2, and e only a1 and e have contributions from all components, namely TAP2⊖ , Fe2⊕ and C22⊖, so that for these races broad energy bands can be expected. The a2, b1, and b2 MOs of the TAP-FeII subunits are separated fairly well and have no counterparts in the C22⊖ bridges so that very narrow bands should arise. This is confirmed by an EH calculation. Unexpectedly the a1 bonds which have contributions from the σ-MOS of C22⊖ are broader than the e-bands which contain the two crossed π-MO systems of C22⊖ . The quantitative results of the nearly self-consistent iterative EH calculation indicate overlap of the energy bands near the Fermi level and fulfill thus one necessary condition for metal-like electrical conductivity.

Rat liver nuclear skeleton and small molecular weight RNA species.

Small molecular weight RNA species (smwRNAs) were studied in rat liver nuclei with and without chromatin as well as with and without nuclear envelope and nucleoplasm. From all the species identified, only two, N5 and 5Sb, were related to ribosomes. The others were localized exclusively in the nuclear skeleton or the spongelike network that was described in the preceding communication. This network or protein matrix contains a less abundant but exclusive set of molecules designated 5Sa, N1, and 4.5S, as well as other more abundant molecules which also exist in rat liver endoplasmic reticulum but not in polysomes or postribosomal RNP complexes. The smwRNAs behave like HnRNA; they remain located in the nuclear skeleton when nuclei are deprived of nucleoplasm and chromatin. With the information presently available, it is not possible to know whetherer both species are in the same or different RNP complexes and whether some of the smwRNAs contribute to the architecture of the nuclear skeleton. Distinct from any other nuclear RNA species, smwRNAs have two unique properties: facility of extraction, and resistance to nuclear ribonuclease digestion.

RESISTANCE OF THE MOUSE'S INTESTINAL TRACT TO EXPERIMENTAL SALMONELLA INFECTION

Determinations of pH, Eh, and concentrations of acetic, butyric and lactic acids were made on the content of cecum and transverse colon of groups of mice killed 1, 3, and 5 days after oral administration of 50 mg streptomycin. Control observations on untreated mice are reported in the preceding communication. Heat-killed supenatants of suspensions of bowel content were tested in vitro for their ability to inhibit multiplication of our standard streptomycin-resistant strain of Salmonella enteritidis during aerobic and anaerobic incubation. Also tested in like fashion were series of cultures in broth buffered at various pH levels and containing acetic, butyric, and lactic acids in varying concentrations. In colon content of mice on the 1st day after streptomycin treatment, the pH had risen and the concentrations of the fatty acids fallen, a combination of effects which adequately accounts for its inability to inhibit multiplication of Salmonella in vitro and in vivo. By the 3rd day after streptomycin treatment, pH and fatty acid concentrations had returned to normal levels. The susceptibility of mice to oral challenge on the 3rd day was explained by the finding that lactic acid had accumulated in colon content to levels which, in broth, effectively counteracted the activity of inhibitory concentrations of the fatty acids. Other cocarboxylic acids also antagonized the inhibitory activity of the fatty acids; glucose did not.

Letters to the Editor

The dosage of gamma-globulin recommended for adults for the prevention of hepatitis with jaundice in the 1961 edition of the "Redbook" of the American Academy of Pediatrics has been questioned by Drs. Gellis and McComb in the preceding communication. The Committee on Control of Infectious Diseases, which is charged with the revision of the "Redbook," realizes that the optimum dose of gamma-globulin for adults is not known. Although there is good evidence based on well-controlled studies that 0.01 ml/lb is effective in preventing jaundice in children, comparable evidence is lacking for adults.

2. Solar granulation photographs from the stratosphere

The Princeton University Observatory carried out last summer three unmanned stratospheric balloon nights for the same purpose as that described in the preceding communication, namely to obtain high-definition photographs of the solar granulation. The special telescope for this purpose was built by the Perkin-Elmer Corporation, the electronic pointing mechanism was constructed by the Boulder Research Laboratories, and the balloons were manufactured and flown by General Mills Inc. The project was sponsored by the U.S. Office of Naval Research and by the U.S. Air Force.

The nutritive value of fodder cellulose from wheat straw. II. The utilization of cellulose by growing and fattening pigs

The fodder cellulose used in this investigation was prepared from wheat straw by the factory process described in the preceding communication. It was dried and milled, so that the resultant material was light and fluffy in character, with the fibres well frayed. This was considered to be important, since the physical state of the cellulose might exert a considerable influence on the ability of the intestinal bacteria to bring about its fermentation and breakdown.It was shown in the preceding paper that the fodder cellulose, on the basis of dry matter, contains 79·8% of crude fibre, of 85·1% digestibility, and 69·2% of ‘total digestible nutrients’. The present feeding trial has demonstrated that the figure for ‘total digestible nutrients’ obtained from the results of the pig digestion trial is a true measure of the productive value of the fodder cellulose for growth and fattening in bacon pigs, provided that the product is fed in a finely divided condition and in intimate admixture with the meal forming the rest of the ration.

Studies of Hard Rubber Reactions. III. Changes in Acetone-Extractable Substances during Vulcanization

1. To explain chemically the fundamental hard rubber reactions which take place during the vulcanization, changes in the acetone-extractable substances, as well as in tensile strength, elongation, and hardness, during vulcanization were studied. 2. Preliminary experiments on acetone extraction with the author's apparatus indicated that a 20-hour extraction was ideal for the purposes of the investigation, and extractions extending to extremely long periods were unsuitable in the present experiments. 3. The corrected acetone extract or organic acetone-soluble substances do not either increase or diminish steadily throughout vulcanization, but show a maximum value at a definite period of vulcanization. The appearance of this maximum value, which also corresponds to characteristic changes in tensile strength, elongation, and hardness (cf. the preceding Communication) is a turning point where the hard rubber reaction diminishes rapidly. 4. To explain chemically the appearance of a maximum value and consequent increase and decrease in the percentage of acetone-soluble substances (corrected) it may be considered that the rubber or rubber compounds with different degrees of vulcanization are polymerized at a certain period of vulcanization, depending on the action of heat, accelerators and agencies, and that the amount of acetone-soluble substances is governed by these factors.

The products of partial hydrogenation some higher polyethylenic esters

It is well known that, when an unsaturated higher fatty acid ester (such as methyl linoleate or linolenate) is hydrogenated, the process is largely selective, and no fully-saturated ester is produced until nearly 90 per cent, of the polyethylenic ester has been transformed into monoethylenic compounds ( i. e ., methyl oleate and iso-oleates). Accordingly, if the monoethylenic esters produced by selective hydrogenation of, for example, methyl linolenate. CH 3 . CH 2 . CH : CH . CH 2 . CH : CH. CH 2 . CH : CH. [CH 2 ] 7 . COOMe were a mixture of the esters of Δ 9 : 10 -, Δ 12 : 13 -, and Δ 15 : 16 -octadecenoic acids in more or less equivalent proportions, it should be possible to determine the position of the ethylenic linkages in the original compound by careful oxidation of the mixture of methyl oleates formed, according to the methods given in the preceding communication.