That is what most of us believe most of the time. They do happen, of course, sometimes with alarming frequency, sometimes with calamitous results. We explain these unnatural events as the consequences of lack of foresight, poor design, poor engineering andlor errors by some person or persons. Improve the design and production, admonish or train the persons to be more careful (less careless?) and they won't happen. It is easy to think of examples in the home, the laboratory, the office ... and in the public domain -for example, Chernobyl, Challenger, Bhopal, The Herald of Free Enterprise, King's Cross. The premise leads to an explanation of the cause, which in turn leads to the public inquiry recommending some action to prevent a similar accident occumng again. Chernobyl, for example, was blamed on a combination of unsatisfactory design and operator error. So also was the Zeebrugge disaster. So also ... and it is easy to make a long list including Flixborough, Torrey Canyon, Three Mile Island (TMI), to which King's Cross will probably soon be added. In each case the inquiry has prescribed corrective action based on this 'accidents are unnatural' (AAU) model: a technological fix plus wrist-slapping. In well-established technologies, in which we have many thousands or even millions of operating hours of experience. the repeated application of this process should by now have reduced the accident rate to zero -or, at the very least, to very nearly zero. Not a bit of it; there are no signs of this happening, and in some technologies the rate is rising. Could it be that we have got something wrong in our explanation?

Normal accidents. Living with high-risk technologies

A safe surgery saves lives

Health Professional Mobility and Health Systems: Evidence from 17 European Countries

Continuous telemonitoring of vital signs in a clinical or home setting may lead to improved knowledge of patients' baseline vital signs and earlier detection of patient deterioration, and it may also facilitate the migration of care toward home. Little is known about the performance of available wearable sensors, especially during daily life activities, although accurate technology is critical for clinical decision-making.The aim of this study is to assess the data availability, accuracy, and concurrent validity of vital sign data measured with wearable sensors in volunteers during various daily life activities in a simulated free-living environment.Volunteers were equipped with 4 wearable sensors (Everion placed on the left and right arms, VitalPatch, and Fitbit Charge 3) and 2 reference devices (Oxycon Mobile and iButton) to obtain continuous measurements of heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), and temperature. Participants performed standardized activities, including resting, walking, metronome breathing, chores, stationary cycling, and recovery afterward. Data availability was measured as the percentage of missing data. Accuracy was evaluated by the median absolute percentage error (MAPE) and concurrent validity using the Bland-Altman plot with mean difference and 95% limits of agreement (LoA).A total of 20 volunteers (median age 64 years, range 20-74 years) were included. Data availability was high for all vital signs measured by VitalPatch and for HR and temperature measured by Everion. Data availability for HR was the lowest for Fitbit (4807/13,680, 35.14% missing data points). For SpO2 measured by Everion, median percentages of missing data of up to 100% were noted. The overall accuracy of HR was high for all wearable sensors, except during walking. For RR, an overall MAPE of 8.6% was noted for VitalPatch and that of 18.9% for Everion, with a higher MAPE noted during physical activity (up to 27.1%) for both sensors. The accuracy of temperature was high for VitalPatch (MAPE up to 1.7%), and it decreased for Everion (MAPE from 6.3% to 9%). Bland-Altman analyses showed small mean differences of VitalPatch for HR (0.1 beats/min [bpm]), RR (-0.1 breaths/min), and temperature (0.5 °C). Everion and Fitbit underestimated HR up to 5.3 (LoA of -39.0 to 28.3) bpm and 11.4 (LoA of -53.8 to 30.9) bpm, respectively. Everion had a small mean difference with large LoA (-10.8 to 10.4 breaths/min) for RR, underestimated SpO2 (>1%), and overestimated temperature up to 2.9 °C.Data availability, accuracy, and concurrent validity of the studied wearable sensors varied and differed according to activity. In this study, the accuracy of all sensors decreased with physical activity. Of the tested sensors, VitalPatch was found to be the most accurate and valid for vital signs monitoring. 

https://jmir.org/api/download?alt_name=formative_v6i1e30863_app1.pdf&filename=ff2a9e2430b13714c8f466ef8b17f289.pdf

Continuous Monitoring of Vital Signs With Wearable Sensors During Daily Life Activities: Validation Study

Sex and gender differences in anesthesia: Relevant also for perioperative safety?

Patient safety is an activity to mitigate preventable patient harm that may occur during the delivery of medical care. The European Board of Anaesthesiology (EBA)/European Union of Medical Specialists had previously published safety recommendations on minimal monitoring and postanaesthesia care, but with the growing public and professional interest it was decided to produce a much more encompassing document. The EBA and the European Society of Anaesthesiology (ESA) published a consensus on what needs to be done/achieved for improvement of peri-operative patient safety. During the Euroanaesthesia meeting in Helsinki/Finland in 2010, this vision was presented to anaesthesiologists, patients, industry and others involved in health care as the 'Helsinki Declaration on Patient Safety in Anaesthesiology'. In May/June 2020, ESA and EBA are celebrating the 10th anniversary of the Helsinki Declaration on Patient Safety in Anaesthesiology; a good opportunity to look back and forward evaluating what was achieved in the recent 10 years, and what needs to be done in the upcoming years. The Patient Safety and Quality Committee (PSQC) of ESA invited experts in their fields to contribute, and these experts addressed their topic in different ways; there are classical, narrative reviews, more systematic reviews, political statements, personal opinions and also original data presentation. With this publication we hope to further stimulate implementation of the Helsinki Declaration on Patient Safety in Anaesthesiology, as well as initiating relevant research in the future.

/pdf/ten-years-of-the-helsinki-declaration-on-patient-safety-in-15i27sddjx.pdf

Ten years of the Helsinki Declaration on patient safety in anaesthesiology: An expert opinion on peri-operative safety aspects

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Ten years of the Helsinki Declaration on patient safety in anaesthesiology: An expert opinion on peri-operative safety aspects