A Simulation Study on Handoffs and Cross-coverage: Results of an Error Analysis.

Handoffs and cross-coverage are necessary for maintaining the continuity of patient care, yet both are potential sources of error, and may threaten patient safety and care. Handoffs are the transfer of patient information and accountability from one provider to another. Cross-coverage is the management of patients, of whom physicians who have little or no prior knowledge of, during nightshifts. We observed how physicians give a sign-out after receiving a handoff in a simulated session of an evening handoff and start of nightshift. We collected data from thirty physicians from an academic medical center as they signed out six patients after responding to nurse calls. An error analysis of the sign-out data revealed 42 errors overall, with 28 omissions and 14 "erroneous data" errors. We then propose ways to prevent these errors through modification of the electronic medical record and support tools, and through higher awareness of human factors.

Greek language processing in naive and skilled readers: Functional properties of the VWFA investigated with ERPs.

Neuroimaging studies have provided evidence that the orthographic properties of linguistic stimuli are processed within the visual word form area (VWFA) localised in the left inferotemporal cortex (Cohen & Dehaene, 2004). It is not, however, clear in the literature whether this region responds preferentially to words, distinguishing them from pseudowords, or whether the pseudowords are distinguished from letter-strings on the basis of their orthographic regularity, or again, whether the VWFA distinguishes letters from numbers or from visual stimuli such as chequerboards. Very recently, it has been claimed that there is no evidence that the ill-named VWFA changes its responsiveness during or after reading acquisition (Price & Devlin, 2004). In order to simulate a condition of pre-reading ability in adult readers, we performed this study, in which we compared processing of Greek words and legal pseudowords in mother-tongue Greeks (skilled readers) and monolingual Italian individuals (naive readers) who had no familiarity with the Greek alphabet. ERPs were recorded while volunteers were engaged in a task involving the identification and response to target letters contained within Greek words or pseudowords. The response speed was identical in the two groups (550 vs. 557 ms). ERP data showed that at 165 ms post-stimulus (N1 component) the left lateral-occipital scalp area, probably corresponding to the left ventral occipitotemporal sulcus, discriminates letters of a familiar alphabet, while an unknown alphabet also activates the homologous right-hemispheric region more than 100 ms later. This suggests that the VWFA discriminates nonalphabetic symbols from letter-strings. An analysis of the N2 component showed an increase in the activation of the same region at about 285 ms post-stimulus during the processing of words rather than pseudowords in skilled readers, thus supporting the view that the VWFA discriminates words on the basis of their familiarity. The data seem to suggest that the VWFA is alphabet-specific and that it is based on the shaping of visual area activity during acquisition of the ability to read a given symbolic code.