BackgroundTo use advanced medical technologies (AMTs) correctly and safely requires both specialist knowledge and skills, and an awareness of risks and how those can be minimized. Reporting safety concerns about AMTs in home care can contribute to an improved quality of care. The extent to which a health care organization has integrated the reporting, evaluation and learning from incidents is a key element of that organization's patient safety culture.ObjectivesTo explore nurses' experiences regarding the education followed in the use of AMTs in the home setting, and their organizations' systems of reporting.DesignDescriptive cross-sectional design.Methods209 home care nurses from across the Netherlands who worked with infusion therapy, parenteral nutrition and/or morphine pumps responded to the online questionnaire between July 2018 and February 2019. The analysis of the data was mainly descriptive.ResultsEducational interventions that are most often used to learn how to use AMTs were, as an average over the three AMTs, instruction by a nurse (71%), practical training in the required skills (71%) and acquiring information to increase theoretical knowledge (69%). Considerable attention is paid to patient safety (88%) and the home setting (89%). However, a substantial proportion of the nurses (up to 29%) use AMTs even though they had not been tested on their skills. 95% of the respondents were well acquainted with the incident reporting protocol of their organization, but only 49% received structural or regular feedback on any actions taken as a result of event reporting.ConclusionsThis study revealed aspects of nurses' education that imply risk factors for patient safety. Practical training is not always given, additional or retraining is often voluntary, and the required skills are not always tested. However, the results show that nurses do have a good awareness of patient safety. Incidents are mainly discussed within the team, but less at the organizational level.
In cases of sexual assault, the interpretation of biological traces on clothing, and particularly undergarments, may be complex. This is especially so when the complainant and defendant interact socially, for instance as (ex-)partners or by co-habitation. Here we present the results from a study where latent male DNA on female worn undergarments is recovered in four groups with different levels of male-female social interaction. The results conform to prior expectation, in that less interaction tend to result in less male DNA on undergarments. We explore the use of these experimental data for evaluative reporting given activity level propositions in a mock case scenario. We show how the selection of different populations to represent the social interaction between complainant and defendant may affect the strength of the evidence. We further show how datasets of limited size can be used for robust activity level evaluative reporting.
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There appears to be some hesitation within the forensic biology community to formally evaluate and report on findings given activity level propositions. This hesitance in part stems from concerns about the lack of relevant data on the dynamics of biological traces and doubt about the relevance of such expert opinions to the trier of fact. At the Netherlands Forensic Institute formal evaluative opinions on the probability of case findings given propositions at the activity level are provided since 2013, if requested by a mandating authority. In this study we share the results from a retrospective analysis of 74 of such requests. We explore which party initiates requests, the types of cases that are submitted, the sources of data being used to assign probabilities to DNA transfer, persistence, prevalence and recovery (TPPR) events, the conclusions that were drawn by the scientists, and how the conclusions were used by the courts. This retrospective analysis of cases demonstrates that published sources of data are generally available and can be used to address DNA TPPR events in most cases, although significant gaps still remain. The study furthermore shows that reporting on forensic biology findings given activity level propositions has been generally accepted by the district and appeal courts, as well as the other parties in the criminal justice system in the Netherlands.
