eLetters

26 e-Letters

published between 2003 and 2006

  • Authors' response
    Hardeep Singh

    Dear Editor,

    We thank Dr. McCarthy for his thoughtful insights on the application of situational awareness (SA) in medicine. We agree that physicians begin with a limited amount of SA and often fail to maximize their SA using a team approach. Because of the increasing complexity and acuity of care in the outpatient setting, the risk of outpatient medical errors has increased during the past several years.[1] Thus, t...

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  • Situational Awareness in medicine
    Geoffrey W McCarthy

    Dear Editor,

    As a retired USAF pilot-physician, I commend Singh et al. for their excellent use of aviation Situational Awareness as an analysis tool. I wish only to add a subtle dimension to their illustration of situational awareness: "LSA" - loss of situational awareness – began as a universally recognized NATO acronym. But…one can not lose what one never had. SA in military and air carrier aviation universally b...

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  • Changing social relationships
    Nick J Fox

    Dear Editor,

    In his review of our paper on pro-anorexia Internet communities (Quality and Safety in Health Care 2006;15:220-222), Dr Smith introduced one inaccuracy into an otherwise concise summary. He mistakenly attributed a quotation from a participant in the Internet forum to our researcher. Angela (a pseudonym) had commented that she was intending to leave the group because she did not approve of some of t...

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  • Patients Agencies and complaints in Italy
    Roberto Natangelo

    Dear Editor,

    According to MM Bismark et Al (1) complaints that are brought to a Commissioner in NZ offer a potentially valuable “window” on serious threats to patient safety. In Italy, the consultative and conciliatory commissions (“Commissioni miste conciliative”) and the ombudsmen (second level organisations) supply unsatisfactory results or are not even established (2). Furthermore, epidemiological data lik...

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  • Benefits of improving and disseminating evidence on quality improvement projects
    Mano Selvan

    Dear Editor,

    It was a great pleasure to read the article by F. Davidoff and P. Batalden published in October 2005 issue of the journal Quality and Safety in Health Care, pages 807–814. The article clearly pictures how failing to publish quality improvement (QI) may have several adverse implications hindering the overall medical quality improvement expected by consumers, accrediting agencies, federal agencies and...

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  • Making the case for more necropsies to improve patient care
    Megan A Bohensky

    Dear Editor,

    In their recent study, Shojana et al highlight the importance of necropsy to clinical care by demonstrating how diagnostic sensitivity for three conditions is overestimated without necropsy results.[1] This study prompted an editorial by Guly calling for more research to demonstrate that increasing necropsy rates can improve patient care.[2]

    Clearly, the evidence establishing the value of necr...

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  • Cricoid pressure and vomiting
    Erich B Schulz

    Dear Editor,

    I congratulate the authors on this excellent series.

    Some authors (for example[1,2]), regard active vomiting as a contraindication to cricoid pressure because of reported cases of oesaphageal rupture, and cadaveric experiments. This current paper, however, makes no mention of vomiting as a contraindication.

    I would appreciate knowing whether authors reject this contrandication and bel...

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  • IMRaD as a model for quality improvement reports
    Jane M Kyrkjebø

    Dear Editor,

    In the Scandinavian countries we have a lot of discussions related to how to publish quality improvement work, and process oriented writing courses are ongoing. Therefore, this article comes on time. I really agree with the authors that a quality improvement report has to follow the IMRaD-model, and the Table 1 "Draft proposed guidelines for stronger improvement evidence" and Table 2 are really helpfu...

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  • Crucial data
    Eric N Grosch

    Dear Editor,

    The no-child-left-behind program grades schools on the basis of test- scores on their pupils. Waters, Lefevre, and Budetti have arguably developed a far more valid and relevant measure of school-performance by assessing malpractice-experience, as a function of medical school.

    It seems anomalous, even negligent, that the authors would develop data on which medical schools produce graduates wh...

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  • What to do with outliers?
    Gareth J Parry

    Dear Editor,

    The paper by Spiegelhalter is a valuable contribution to the literature on presenting and displaying performance related outcome measures.[1] It provides further methodological guidance on identifying service providers whose performance falls outside control limits using funnel plot methodology. When reporting on performance it is important to have procedures in place which should be followed when...

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