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psnet.ahrq.gov/node/49862/psn-pdf
May 01, 2019 - The Magnetic Deflection
May 1, 2019
Kanal E. The Magnetic Deflection. PSNet [internet]. 2019.
https://psnet.ahrq.gov/web-mm/magnetic-deflection
The Case
A 68-year-old woman with a prior history of cerebrovascular accident and hypertension presented to the
hospital with new left-sided weakness and hypertensive urg…
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psnet.ahrq.gov/node/49467/psn-pdf
December 01, 2004 - A "Weak" Response
December 1, 2004
Reisman AB. A "Weak" Response. PSNet [internet]. 2004.
https://psnet.ahrq.gov/web-mm/weak-response
The Case
A primary care physician on call for his group received a call at 9:00PM from a 68-year-old man. He said,
"They started me on a new pill for my blood pressure and now I fe…
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psnet.ahrq.gov/node/33735/psn-pdf
August 01, 2012 - Medication Safety in Nursing Homes: What's Wrong and
How to Fix It
August 1, 2012
Gurwitz JH. Medication Safety in Nursing Homes: What's Wrong and How to Fix It. PSNet [internet]. 2012.
https://psnet.ahrq.gov/perspective/medication-safety-nursing-homes-whats-wrong-and-how-fix-it
Perspective
At any point in time, …
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psnet.ahrq.gov/web-mm/outpatient-zebra
January 23, 2020 - An Outpatient 'Zebra'
Citation Text:
Berkowitz L. An Outpatient 'Zebra'. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2006.
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Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMe…
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psnet.ahrq.gov/node/49435/psn-pdf
February 01, 2004 - X-ray Flip
February 1, 2004
Shapiro MJ. X-ray Flip. PSNet [internet]. 2004.
https://psnet.ahrq.gov/web-mm/x-ray-flip
The Case
A 19-year-old man presented to the emergency department with respiratory distress after blunt chest
trauma. A digital chest radiograph was labeled backwards; a "left" marker was mistakenly…
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psnet.ahrq.gov/node/843736/psn-pdf
February 01, 2023 - Saved by ECMO
February 1, 2023
Weiss NA. Saved by ECMO . PSNet [internet]. 2023.
https://psnet.ahrq.gov/web-mm/saved-ecmo
The Case
A 27-year-old pregnant woman was admitted at an estimated gestational age (EGA) of 29 weeks for
increased shortness of breath. She was diagnosed with severe pulmonary arterial hyperte…
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psnet.ahrq.gov/perspective/conversation-edward-tenner-phd
June 01, 2011 - In Conversation with… Edward Tenner, PhD
June 1, 2011
Also Read an Essay
Citation Text:
In Conversation with… Edward Tenner, PhD. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2011.
Cop…
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psnet.ahrq.gov/node/851971/psn-pdf
July 31, 2023 - Failure to Adhere to Dietary Restrictions Leading to
Complications and Poor Follow-up
July 31, 2023
Bohringer C, Bourgeois J, Xiong G, et al. Failure to adhere to dietary restrictions leading to complications
and poor follow-up. PSNet [internet]. 2023.
https://psnet.ahrq.gov/web-mm/failure-adhere-dietary-restricti…
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psnet.ahrq.gov/perspective/conversation-withdavid-marx-jd
October 01, 2007 - In Conversation with...David Marx, JD
October 1, 2007
Also Read an Essay
Citation Text:
In Conversation with..David Marx, JD. PSNet [internet]. 2007.In Conversation with...David Marx, JD. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Qualit…
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psnet.ahrq.gov/perspective/conversation-withsir-liam-donaldson-md-msc
May 01, 2007 - NPSA, including redesigning the national reporting system to take more account of analyzing risk-prone situations
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psnet.ahrq.gov/perspective/conversation-withallan-frankel-md
July 01, 2006 - The feedback loop needs to be closed by getting back to those who have reported incidents and unsafe situations
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psnet.ahrq.gov/perspective/patient-safety-united-kingdom-evolution-and-progress
May 01, 2007 - NPSA, including redesigning the national reporting system to take more account of analyzing risk-prone situations
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psnet.ahrq.gov/perspective/key-issues-developing-successful-hospital-safety-program
July 01, 2006 - The feedback loop needs to be closed by getting back to those who have reported incidents and unsafe situations
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psnet.ahrq.gov/perspective/conversation-withlucian-leape-md
August 01, 2006 - lesson: enlightened, risk-taking leadership is the only way to achieve significant culture change in situations
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psnet.ahrq.gov/perspective/conversation-withrobert-m-wachter-md
October 01, 2008 - expected norms and incidental lysis of adhesions (both relatively trivial procedures) to life-threatening situations
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psnet.ahrq.gov/issue/panel-discussion-error-proofing-your-pharmacy
April 05, 2006 - Audiovisual
Panel Discussion: Error Proofing Your Pharmacy.
Citation Text:
Chi J; Bootman L; Cohen M; Fong D; Jorgenson J, Ravnan S; Mayer F; Laborsky J.
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psnet.ahrq.gov/issue/mandatory-error-reporting-discourages-disclosure-information
October 26, 2011 - Newspaper/Magazine Article
Mandatory error reporting discourages disclosure of information.
Citation Text:
Tokarski C
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April …
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psnet.ahrq.gov/issue/tragic-medication-errors-result-accidental-abortions-and-premature-birth-safety-advocates-say
August 21, 2019 - Audiovisual Presentation
Tragic medication errors result in accidental abortions and premature birth—safety advocates say drug mistakes are still too frequent, despite advances.
Citation Text:
Patel A; ABCnews.com
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psnet.ahrq.gov/issue/ihi-fellowship-program
December 13, 2017 - Press Release/Announcement
IHI Fellowship Program.
Citation Text:
Institute for Healthcare Improvement.
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June 3, 2024
Instit…
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psnet.ahrq.gov/node/49587/psn-pdf
May 01, 2009 - Missing Trauma
May 1, 2009
Jurkovich GJ. Missing Trauma. PSNet [internet]. 2009.
https://psnet.ahrq.gov/web-mm/missing-trauma
The Case
A 54-year-old woman collapsed behind the counter of a small neighborhood market. She was discovered a
few minutes later by a customer, who immediately called 911. On arrival, para…