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1981. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49427/psn-pdf
      January 01, 2004 - Inadvertent Castration January 1, 2004 Calland FJ. Inadvertent Castration. PSNet [internet]. 2004. https://psnet.ahrq.gov/web-mm/inadvertent-castration The Case An 83-year-old man presented with a left groin mass, "which had been there for years" but had recently increased in size. The patient described persisten…

1982. Hazards of Loading Doses | PSNet
      psnet.ahrq.gov/web-mm/hazards-loading-doses
      December 01, 2003 - Hazards of Loading Doses Citation Text: Mucksavage JJ, Tesoro EP. Hazards of Loading Doses. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2017. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML E…

1983. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49854/psn-pdf
      February 01, 2019 - Diagnostic Failure: The Growing Deficit February 1, 2019 Chang R, Flanders S. Diagnostic Failure: The Growing Deficit. PSNet [internet]. 2019. https://psnet.ahrq.gov/web-mm/diagnostic-failure-growing-deficit The Case A 65-year-old woman with a history of diabetes and hypertension was admitted to a hospital's telem…

1984. PowerPoint Presentation (ppt file)
      psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.338_slideshow.ppt
      January 01, 2015 - PowerPoint Presentation Spotlight Monitoring Fetal Health 1 This presentation is based on the January 2015 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: Mark W. Scerbo, PhD, Department of Psychology, Old Dominion University, and Alfred Z. Abuham…

1985. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/853772/psn-pdf
      September 27, 2023 - Insulin Administration: Pen vs Vial – Similar, but Not Interchangeable September 27, 2023 Camarillo H. Insulin Administration: Pen vs Vial – Similar, but Not Interchangeable. PSNet [internet]. 2023. https://psnet.ahrq.gov/web-mm/insulin-administration-pen-vs-vial-similar-not-interchangeable The Case A fourteen-ye…

1986. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49629/psn-pdf
      June 01, 2011 - Say It Again June 1, 2011 Henriksen K, Hall KK. Say It Again. PSNet [internet]. 2011. https://psnet.ahrq.gov/web-mm/say-it-again The Case A 72-year-old man was admitted to the hospital with community-acquired pneumonia and hyponatremia. During his third hospital night, the on-call physician was contacted by the c…

1987. Spotlight (pdf file)
      psnet.ahrq.gov/sites/default/files/2020-02/final_spotlight_opat_powerpoint_01102020_tocme.pdf
      January 01, 2020 - Spotlight Spotlight Discharged with IV antibiotics: When issues arise, who manages the complications? Source and Credits • This presentation is based on the February 2020 AHRQ WebM&M Spotlight Case ○ See the full article at https://psnet.ahrq.gov/webmm ○ CME credit is available • Commentary by: Monica Donnel…

1988. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33705/psn-pdf
      January 01, 2011 - Risk Management and Patient Safety December 1, 2010 Manuel BM, McCarthy JL, Berry WR, et al. Risk Management and Patient Safety. PSNet [internet]. 2010. https://psnet.ahrq.gov/perspective/risk-management-and-patient-safety Perspective In 1990, a Harvard-based research team reported the incidence of medical errors …

1989. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49847/psn-pdf
      November 01, 2018 - Written Signout: It Only Works If You Use The Right One November 1, 2018 Lewis K, Rosenbluth G. Written Signout: It Only Works If You Use The Right One. PSNet [internet]. 2018. https://psnet.ahrq.gov/web-mm/written-signout-it-only-works-if-you-use-right-one The Case A 75-year-old man was hospitalized due to a stro…

1990. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33763/psn-pdf
      March 01, 2014 - How Does Infection Prevention Fit Into a Safety Program? March 1, 2014 Huang SS. How Does Infection Prevention Fit Into a Safety Program? PSNet [internet]. 2014. https://psnet.ahrq.gov/perspective/how-does-infection-prevention-fit-safety-program Perspective In 1999, the Institute of Medicine (IOM) released the To …

1991. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33629/psn-pdf
      March 01, 2006 - What Does Simulation Add to Teamwork Training? March 1, 2006 Gaba DM. What Does Simulation Add to Teamwork Training? PSNet [internet]. 2006. https://psnet.ahrq.gov/perspective/what-does-simulation-add-teamwork-training Editor's Note: In these point–counterpoint articles, Drs. Pratt and Sachs of Beth Israel Deacones…

1992. Improving Patient Safety and Team Communication through Daily Huddles | PSNet
      psnet.ahrq.gov/primer/improving-patient-safety-and-team-communication-through-daily-huddles
      December 15, 2024 - Improving Patient Safety and Team Communication through Daily Huddles Citation Text: Shaikh U. Improving Patient Safety and Team Communication through Daily Huddles. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2020. Copy Citatio…

1993. Misplaced Vial: Medication Kit Variability Contributes to Medication Error During Patient Transport | PSNet
      psnet.ahrq.gov/web-mm/misplaced-vial-medication-kit-variability-contributes-medication-error-during-patient
      March 12, 2021 - Misplaced Vial: Medication Kit Variability Contributes to Medication Error During Patient Transport Citation Text: MacDowell P, McGee E. Misplaced Vial: Medication Kit Variability Contributes to Medication Error During Patient Transport. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Q…

1994. One ACE Too Many | PSNet
      psnet.ahrq.gov/web-mm/one-ace-too-many
      June 21, 2016 - One ACE Too Many Citation Text: Juurlink DN. One ACE Too Many. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2006. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …

1995. In Conversation With… Susan Haas, MD, MSc | PSNet
      psnet.ahrq.gov/perspective/conversation-susan-haas-md-msc
      March 01, 2019 - In Conversation With… Susan Haas, MD, MSc March 1, 2019  Also Read an Essay Citation Text: In Conversation With… Susan Haas, MD, MSc. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019. …

1996. In Conversation With… David M. Gaba, MD | PSNet
      psnet.ahrq.gov/perspective/conversation-david-m-gaba-md
      March 01, 2013 - In Conversation With… David M. Gaba, MD March 1, 2013  Also Read an Essay Citation Text: In Conversation With… David M. Gaba, MD. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2013. Copy…

1997. A framework for assessing reasoning about controversial end-of-life clinical decisions. | PSNet
      psnet.ahrq.gov/web-mm/framework-assessing-reasoning-about-controversial-end-life-clinical-decisions
      November 30, 2023 - A framework for assessing reasoning about controversial end-of-life clinical decisions. Citation Text: Fedyk M, Fairman N, Romano PS, et al. A framework for assessing reasoning about controversial end-of-life clinical decisions.. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality…

1998. In Conversation With... Cindy Brach | PSNet
      psnet.ahrq.gov/perspective/conversation-cindy-brach
      December 27, 2019 - In Conversation With... Cindy Brach December 27, 2019  Also Read the Essay Citation Text: In Conversation With.. Cindy Brach. PSNet [internet]. 2019.In Conversation With... Cindy Brach. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, …

1999. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49422/psn-pdf
      November 01, 2003 - 40 of K November 1, 2003 Lesar TS. 40 of K. PSNet [internet]. 2003. https://psnet.ahrq.gov/web-mm/40-k The Case An 81-year-old female maintained on warfarin for a history of chronic atrial fibrillation and mitral valve replacement developed asymptomatic runs of ventricular tachycardia while hospitalized. The unit…

2000. An Untimely End Despite End-of-Life Care Planning | PSNet
      psnet.ahrq.gov/web-mm/untimely-end-despite-end-life-care-planning
      February 01, 2012 - An Untimely End Despite End-of-Life Care Planning Citation Text: Elia G, Barbour S, Anderson WG. An Untimely End Despite End-of-Life Care Planning. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2018. Copy Citation Format: …