eLetters

25 e-Letters

published between 2000 and 2003

  • What is a 'safety culture'?
    Martin N Marshall

    Dear Editor

    We welcome Singer and colleague’s contribution to developing the concept of a safety culture.[1] Policy-makers, managers and clinicians are slowly realising that patient safety will not be improved solely by counting adverse events or by introducing technical innovations. History tells us that when these initiatives are evaluated the results will probably show a marginal impact on patient safety, and one...

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  • General practice accreditation is only a small part of a comprehensive quality improvement strategy
    Laurence A Malcolm

    Dear Editor

    Buetow and Wellingham present a comprehensive overview of accreditation of general practices in New Zealand, and elsewhere, in this well-written article.[1] They make the very significant point about the limitations of quality assurance as compared with the more important performance outcome orientation of continuous quality improvement.

    However I am puzzled that they make no reference to the...

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  • Re Article: Qual Saf Health Care 2003; 12 : 112-118
    Nesamani K.S.Vengadasalam

    Dear Editor

    Congratulations to the authors for this wonderful comprehensive survey undertaken across 15 hospitals regarding safety cultures. The results of an overall response rate of only 47.4%, was largely due to the poor response for physicians (33%) . Efforts need to be taken to increase the response rate for a more reliable study result. The majority of participants in the survey responded in ways which in...

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  • Postmarketing surveillance for adverse drug effects
    Richard A. Deyo

    Dear Editor

    Doctors Santiago, Debanne, and Neuhauser correctly point out the frequent deficiencies in post-marketing surveillance of newly marketed drugs.[1] Because of aggressive marketing to physicians and direct-to- consumer advertising in the US, a new drug can now have very rapid dissemination, exposing large populations in a short time. Passive surveillance with ambiguous definitions of adverse effects may ofte...

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  • The junior doctor's perspective
    Waheeda Rahman

    Dear Editor

    In response to the recent article in QSHC by A Coulter,[1] as a junior ophthalmic surgeon in training it worries me to see such views expressed as it has seriously detrimental consequences on our training.

    It seems that Ms Coulter is suggesting that only Consultants or very senior, experienced surgeons should be operating on patients and any "junior" member operating would put a patient at ser...

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  • The reality of redesign
    Mark Lubliner

    Dear Editor

    Regarding the article by L Locock,[1] we would like to share our healthcare redesign experiences with you. In recognising that up to 19.4% of all adverse patient events are attributable to medication mishap, Bayside Health Service (Melbourne, Australia) has identified medication safety as a priority.[2-5] A multidisciplinary Drug Management Committee was established to identify systemic factors contr...

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  • Tracking adverse events in randomize control trials the lack of agreement among regulatory instituti
    Luis Manuel Santiago

    Dear Editor

    We need to do a better job of keeping track of potential side effects when designing randomized clinical trials (RCTs). Consider a RCT for a new drug tested for the main, or first order effect, the reduction of hypertension. Power calculations are carried out so that meaningful differences between the drug users and the controls can be detected on this effect. Second order effects, mortality in this case, a...

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  • Prescribing costs of dispensing doctors
    Michael Wilcock

    Dear Editor

    Watkins and colleagues[1] add to the growing literature on the many and varied influences on general practitioner prescribing behaviour and costs.[2,3] They argue, from the results of their analyses, that the dispensing status of the general practitioner is a statistically significant predictor associated with high prescribing costs, though it is unclear from their report exactly how many dispensing pract...

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  • GRiP: did it have an effect?
    Nick A Black

    Dear Editor

    Milne and Hill suggest the 'Getting Research into Practice' programme may have contributed to the decline in surgery for glue ear that we have reported. We cannot, however provide any evidence to support this suggestion. The rate of decline in surgery throughout England was similar to that observed in 13 former health districts in the Oxford/Anglia region. The ratio of change in rates after 1992 over the...

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  • Guidelines can be derived from research into quality programmes
    John A Ovretveit

    Dear Editor

    I would like to thank Dr Checkland for her thoughtful comments on our paper about evaluating quality programmes. I have some sympathy with her views and for the intriguing proposal about research in this area which she makes. I would agree that insufficient attention has been given to how features of organisations described in organisational theory influences how quality programmes are carried throu...

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