When is "good enough"? The role and responsibility of physicians to improve patient safety.

In September 2001, the Agency for Healthcare Research and Quality (AHRQ) and the ABIM Foundation jointly sponsored an invitational conference entitled "The Role and Responsibility of Physicians to Improve Patient Safety." The goal of the conference was to begin a national conversation focusing on the individual clinician's role and strategies physicians might employ to advance patient safety. The authors summarize the main themes and issues that emerged at the conference. The authors draw from work by the Institute of Medicine (IOM) to support the need for greater emphasis on quality improvement. To date, most of the work in this area has involved a systems-level approach, and physicians are often viewed as obstacles to improvement programs. By contrast, physicians may view population- or systems-based approaches to health care as interfering with the delivery of care to specific patients. The authors argue that physicians, individually and collectively, have a key role in quality improvement efforts, albeit a role that is yet fully defined. After reviewing successful examples involving physicians, the authors explore the major levers to achieve change-removing barriers, creating incentives, emphasizing collaboration, increasing education, and promulgating regulation-and summarize ten recurring themes, including both current and near-term opportunities, for physicians to exercise leadership in quality improvement and patient safety. Finally, they assert that even modest change can lead to substantial improvements, particularly if medical societies and the profession's standard-setting bodies work together.     

Peer evaluation of the professional behaviors of emergency medical technicians

INTRODUCTION: Professional behavior is one of the cornerstones of effective emergency medical services (EMS) practice and is a required part of the National Standard Curricula for advanced levels of EMS education. However, peer rating of emergency medical technicians with respect to the 11 categories of professional behavior never has been quantified. This study uses a peer evaluation methodology to assess the affective competencies of practicing EMS providers. METHODS: A professional behavior evaluation form was included as part of a survey that was sent to 2,443 randomly selected, nationally registered emergency medical technicians (EMTs). Participants were asked to rate the EMT partner with whom they worked most closely in the past year using 11 different categories of professional behavior using a Likert scale. RESULTS: One thousand, five hundred, ten (61.8%) surveys were returned and analyzed. Both nationally registered EMTs at the Basic and Paramedic levels rated their partners with respect to 11 categories of professional behavior. The overall average score was 0.68 on a 0-1 scale, with one being the highest. The rating of each of the categories was: (1) integrity (0.77); (2) appearance/personal hygiene (0.74); (3) patient advocacy (0.73); (4) empathy (0.72); (5) self-confidence (0.70); (6) careful delivery of service (0.70); (7) respect (0.65); (8) communication skills (0.64); (9) time management skills (0.63); (10) teamwork/diplomacy skills (0.62); and (11) self-motivation (0.61). Overall, the NREMT-Paramedics rated their partners significantly lower than did the NREMT-Basics (p = 0.0156) and experienced EMT-Basics rated their partners significantly lower than did the newer EMT-Basics (p = 0.0002). Those EMTs who indicated high satisfaction with their current EMS assignment rated their partner more highly on professional behaviors than did those EMTs who were not as satisfied. CONCLUSION: Overall, EMTs peer evaluation of professional behavior was "good." The behaviors most highly rated were integrity and appearance/personal hygiene. The behaviors rated lowest were self-motivation and team work/diplomacy. It appears that paramedics are more critical of their colleagues than are EMT-Basics, that experienced EMT-Basics are harsher critics than are newer EMT-Basics, and that there is a relationship between job satisfaction and peer evaluation.     

Office parties, drinking and driving, and employer liability

Office parties are fun. They boost morale. They can also go over the line and result in company and personal liability. Holiday parties have ended up in court. This article explores "the line" between a good time and liability. What should you be aware of to protect your company and you?     

Enzymatic characterization of recombinant mouse retinal dehydrogenase type 1

Retinal dehydrogenases (RALDHs) convert retinal into retinoic acids (RAs), which are important signaling molecules in embryogenesis and tissue differentiation. We expressed mouse RALDH type 1 (mRALDH1) in Escherichia coli and studied the kinetic properties of the recombinant enzyme for retinal substrates. Purified recombinant mRALDH1 catalyzed the oxidation of all-trans and 9-cis retinal but not 13-cis retinal, and exhibited two pH optimums, 7.8 and 9.4, for all-trans and 9-cis retinal substrates, respectively. The K(m) for all-trans retinal (11.6 micro M) was 3-fold higher than for 9-cis retinal (3.59 micro M). However, the conversion efficiencies of either all-trans or 9-cis retinal to the respective RAs were similar. MgCl(2) inhibited the oxidation of both all-trans and 9-cis retinal. Chloral hydrate and acetaldehyde competitively suppressed all-trans retinal oxidation with inhibition constants (K(i)) of 4.99 and 49.4 micro M, respectively. Retinol, on the other hand, blocked the reaction uncompetitively. These data extend the kinetic characterization of mRALDH1, provide insight into the possible role of this enzyme in the biogenesis of RAs, and should give useful information on the determination of amino acid residues that play crucial roles in the catalysis of all-trans and 9-cis retinal.