[Innovative training for enhancing patient safety. Safety culture and integrated concepts]. / Neue Trainingsformen und Erhöhung der Patientensicherheit. Sicherheitskultur und integrierte Konzepte.

INTRODUCTION: Patient safety is determined by the performance safety of the medical team. Errors in medicine are amongst the leading causes of death of hospitalized patients. These numbers call for action. Backgrounds, methods and new forms of training are introduced in this article. METHOD: Concepts from safety research are transformed to the field of emergency medical treatment. Strategies from realistic patient simulator training sessions and innovative training concepts are discussed. RESULTS: The reasons for the high numbers of errors in medicine are not due to a lack of medical knowledge, but due to human factors and organisational circumstances. A first step towards an improved patient safety is to accept this. We always need to be prepared that errors will occur. A next step would be to separate "error" from guilt (culture of blame) allowing for a real analysis of accidents and establishment of meaningful incident reporting systems. Concepts with a good success record from aviation like "crew resource management" (CRM) training have been adapted my medicine and are ready to use. These concepts require theoretical education as well as practical training. Innovative team training sessions using realistic patient simulator systems with video taping (for self reflexion) and interactive debriefing following the sessions are very promising. CONCLUSION: As the need to reduce error rates in medicine is very high and the reasons, methods and training concepts are known, we are urged to implement these new training concepts widely and consequently. To err is human - not to counteract it is not.

Morphometric analyses of the electric organ of Torpedo: the influence of different fixative modes on the vesicle diameter.

The influences of various fixatives on the vesicle size of the electric organ of Torpedo marmorate were investigated. Thin section and freeze etched preparations were examined under the electron microscope. In thin section increased vesicle diameters were observed compared with the freeze etched preparations. The same experiments in different torpedo fish led to significantly different vesicle sizes observed. Variations of the molarity, the pH and osmolarities result in particularly high differences in vesicle diameters. Using Karnovsky's method (1965) and a fixative consisting of 2.5% glutaraldehyde in 0.2 M cacodylate buffer, pH 7.2, results in vesicle sizes comparable to those reported by other authors. Results obtained from freeze etched preparations are not comparable in general with results from thin section experiments with the same fixative.

The influence of taipoxin on cholinergic synapses in the electric organ of Torpedo marmorata.

The influences of the snake venom taipoxin on the cholinergic synapses of the electric organ of Torpedo mamorata were investigated. 1. In ultrathin sections presynaptic membrane indentations are noted under the influence of taipoxin/NaCl. 2. The presynaptic membranes often show small interruptions. 3. In taipoxin/horseradish peroxidase incubated organ pieces typical omega-shaped indentations are found, but on the postsynaptic side. 4. The vesicle density decreased under the influence of the taipoxin in contrast untreated cholinergic synapses. 5. In freeze etched preparations no membrane indentations and interruptions are observed, but only a small vesicle density was seen.